MEDICARE: ANTHONY LUCAS ATC

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	2255A2300X	Athletic Trainer		DC

General Provider Information

NPI Number	:	1639681299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY LUCAS ATC

Provider Business Mailing Address
First Line	:	1812 N QUINN ST APT 530
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22209-1340
Country	:	US
Telephone Number	:	951-375-2803
Fax Number	:

Provider Business Practice Location Address
First Line	:	1812 N QUINN ST APT 530
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22209-1340
Country	:	US
Telephone Number	:	951-375-2803
Fax Number	:

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

Provider Enumeration Date	:	11/03/2017
Last Update Date	:	11/03/2017

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