Healthcare Provider Details

I. General information

NPI: 1528238904
Provider Name (Legal Business Name): ANN MARIE LUCADO PT, CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2008
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 FIVE FORKS TRICKUM RD STE 210
LAWRENCEVILLE GA
30044-8183
US

IV. Provider business mailing address

1430 FIVE FORKS TRICKUM RD STE 210
LAWRENCEVILLE GA
30044-8183
US

V. Phone/Fax

Practice location:
  • Phone: 678-377-1738
  • Fax: 678-377-1737
Mailing address:
  • Phone: 678-377-1738
  • Fax: 678-377-1737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251H1200X
TaxonomyHand Physical Therapist
License NumberPT008877
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: