Healthcare Provider Details

I. General information

NPI: 1457277840
Provider Name (Legal Business Name): ELLEN LUCE-MCKAY PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22357 KERENSA LANE
MI WUK VILLAGE CA
95346
US

IV. Provider business mailing address

PO BOX 1240
MI WUK VILLAGE CA
95346-1240
US

V. Phone/Fax

Practice location:
  • Phone: 209-677-9323
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT309576
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: