Provider Demographics
NPI:1447854450
Name:RICKELMAN, LUCAS QUINN (LMT)
Entity type:Individual
Prefix:
First Name:LUCAS
Middle Name:QUINN
Last Name:RICKELMAN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 N MAIN ST STE 9
Mailing Address - Street 2:
Mailing Address - City:SALADO
Mailing Address - State:TX
Mailing Address - Zip Code:76571-5845
Mailing Address - Country:US
Mailing Address - Phone:254-947-0694
Mailing Address - Fax:
Practice Address - Street 1:560 N MAIN ST STE 9
Practice Address - Street 2:
Practice Address - City:SALADO
Practice Address - State:TX
Practice Address - Zip Code:76571-5845
Practice Address - Country:US
Practice Address - Phone:254-947-0694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT133788225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist