MEDICARE: MS. LUCILLE ANN CAIN P.T.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	2049275	TX

General Provider Information

NPI Number	:	1457473886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LUCILLE ANN CAIN P.T.A.

Provider Business Mailing Address
First Line	:	176 COUNTY ROAD 6510
Second Line	:
City	:	DAYTON
State	:	TX
Zip	:	77535-3252
Country	:	US
Telephone Number	:	937-371-2234
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 COLORADO BLVD # 318
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80206-4084
Country	:	US
Telephone Number	:	303-339-7408
Fax Number	:	866-293-4719

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2007
Last Update Date	:	07/08/2007

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