Healthcare Provider Details

I. General information

NPI: 1255298063
Provider Name (Legal Business Name): LUCAS WOLFE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HIOAKS RD
RICHMOND VA
23225-4048
US

IV. Provider business mailing address

2902 N ARTHUR ASHE BLVD APT 135
RICHMOND VA
23230-4344
US

V. Phone/Fax

Practice location:
  • Phone: 804-551-2189
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306606671
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: