Healthcare Provider Details

I. General information

NPI: 1982146270
Provider Name (Legal Business Name): LUCAS EMG SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2016
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 KNOTBREAK RD STE 2
SALEM VA
24153-5404
US

IV. Provider business mailing address

3241 ELECTRIC RD SUITE 1B
ROANOKE VA
24018-6405
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: WENDY LUCAS
Title or Position: OWNER
Credential: PT
Phone: 540-772-8022