Provider Demographics
NPI:1649944018
Name:LEAL, LUCAS (DPT)
Entity type:Individual
Prefix:
First Name:LUCAS
Middle Name:
Last Name:LEAL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 12TH AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3946
Mailing Address - Country:US
Mailing Address - Phone:817-719-7714
Mailing Address - Fax:817-796-1114
Practice Address - Street 1:1001 12TH AVE STE 201
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3946
Practice Address - Country:US
Practice Address - Phone:817-719-7714
Practice Address - Fax:817-796-1114
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2025-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1348949225100000X
TXOR2309772251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1348949OtherPT LICENSE