Provider Demographics
NPI:1053970335
Name:CHANG, LUCAS LIN (PT, DPT, CSCS)
Entity type:Individual
Prefix:DR
First Name:LUCAS
Middle Name:LIN
Last Name:CHANG
Suffix:
Gender:M
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 GREENSPRING DR
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-3114
Mailing Address - Country:US
Mailing Address - Phone:410-989-3833
Mailing Address - Fax:443-842-5766
Practice Address - Street 1:9030 STATE ROUTE 108 STE B
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-1990
Practice Address - Country:US
Practice Address - Phone:410-989-3833
Practice Address - Fax:443-842-5766
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD275042251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic