Healthcare Provider Details

I. General information

NPI: 1245750595
Provider Name (Legal Business Name): KENDRA JACKALYN LUCAS PT, DPT, NBC-HWC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 KLING DR
DAYTON OH
45419-4201
US

IV. Provider business mailing address

620 KLING DR
DAYTON OH
45419-4201
US

V. Phone/Fax

Practice location:
  • Phone: 937-345-3483
  • Fax: 877-865-9852
Mailing address:
  • Phone: 937-345-3483
  • Fax: 877-865-9852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberA-3887738
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT016767
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: