Healthcare Provider Details

I. General information

NPI: 1811313307
Provider Name (Legal Business Name): CHRISTI LYNN LUCAS P.T.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2014
Last Update Date: 03/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1528 FRIENDLY RD
PASADENA MD
21122-5908
US

IV. Provider business mailing address

1528 FRIENDLY RD
PASADENA MD
21122-5908
US

V. Phone/Fax

Practice location:
  • Phone: 410-371-5469
  • Fax: 410-437-6971
Mailing address:
  • Phone: 410-371-5469
  • Fax: 410-437-6971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA2401
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: