Healthcare Provider Details

I. General information

NPI: 1285774745
Provider Name (Legal Business Name): LUCAS PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4325 BRAMBLETON AVE STE A
ROANOKE VA
24018-3404
US

IV. Provider business mailing address

PO BOX 932184
ATLANTA GA
31193-4912
US

V. Phone/Fax

Practice location:
  • Phone: 540-772-8022
  • Fax: 540-772-0294
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: AMANDA STREETER
Title or Position: VICE PRESIDENT
Credential:
Phone: 800-699-9395