Healthcare Provider Details

I. General information

NPI: 1962044875
Provider Name (Legal Business Name): CHRISTOPHER A LUCAS DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2019
Last Update Date: 10/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2503 VIRGINIA LN
CORINTH MS
38834-6530
US

IV. Provider business mailing address

8205 PRESIDENTS DR
HUMMELSTOWN PA
17036-8621
US

V. Phone/Fax

Practice location:
  • Phone: 662-977-7180
  • Fax: 662-977-7182
Mailing address:
  • Phone: 717-839-2188
  • Fax: 717-565-1104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT6661
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: