Healthcare Provider Details

I. General information

NPI: 1386534329
Provider Name (Legal Business Name): LUCAS FLYNN MCQUEEN MS, PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2025
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 WILKES RIDGE DR
RICHMOND VA
23233-7632
US

IV. Provider business mailing address

509 BANCROFT AVE
RICHMOND VA
23222-2808
US

V. Phone/Fax

Practice location:
  • Phone: 804-877-4000
  • Fax:
Mailing address:
  • Phone: 434-409-6455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305217233
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: