Individual
LUCAS BROADHURST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPO
Contact information
Practice address
3001 L ST, SACRAMENTO, CA 95816-5225
(916) 706-1520
(916) 706-1551
Mailing address
1700 N CHRISMAN RD, TRACY, CA 95304-9314
(800) 726-9180
(209) 834-1158
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
—
—
224P00000X
Prosthetist
Primary
—
—
225000000X
Orthotic Fitter
—
—
Other
Enumeration date
06/27/2011
Last updated
01/10/2012
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