Basic Information
| Provider Information | |||||||||
| NPI: | 1053970335 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHANG | ||||||||
| FirstName: | LUCAS | ||||||||
| MiddleName: | LIN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PT, DPT, CSCS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9030 STATE ROUTE 108 STE B | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210451990 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109893833 | ||||||||
| FaxNumber: | 4438425766 | ||||||||
| Practice Location | |||||||||
| Address1: | 9030 STATE ROUTE 108 STE B | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210451990 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109893833 | ||||||||
| FaxNumber: | 4438425766 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2019 | ||||||||
| LastUpdateDate: | 07/07/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | 27504 | MD | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
No ID Information.