Provider Demographics
NPI:1962618926
Name:LADOUCEUR, LUCAS JAY (PT)
Entity type:Individual
Prefix:
First Name:LUCAS
Middle Name:JAY
Last Name:LADOUCEUR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 ROSS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW KENSINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15068-5726
Mailing Address - Country:US
Mailing Address - Phone:904-994-2630
Mailing Address - Fax:
Practice Address - Street 1:806 ROSS AVE
Practice Address - Street 2:
Practice Address - City:NEW KENSINGTON
Practice Address - State:PA
Practice Address - Zip Code:15068-5726
Practice Address - Country:US
Practice Address - Phone:904-994-2630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7605225100000X
TN7483225100000X
OH11460225100000X
CO9513225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist