Healthcare Provider Details

I. General information

NPI: 1215746326
Provider Name (Legal Business Name): CORY BETH LUCATAMO DPT, PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2025
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20268 PLANTATIONS RD STE B
LEWES DE
19958-4622
US

IV. Provider business mailing address

1050 INDUSTRIAL DR STE 210
MIDDLETOWN DE
19709-2803
US

V. Phone/Fax

Practice location:
  • Phone: 302-727-0075
  • Fax: 302-449-2047
Mailing address:
  • Phone: 302-727-0075
  • Fax: 302-449-2047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ1-0015012
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: