Healthcare Provider Details

I. General information

NPI: 1659323533
Provider Name (Legal Business Name): SCOTT L LUCAS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 N LAFAYETTE AVENUE
MOUNDSVILLE WV
26041-1029
US

IV. Provider business mailing address

132 N LAFAYETTE AVENUE
MOUNDSVILLE WV
26041-1029
US

V. Phone/Fax

Practice location:
  • Phone: 304-845-9550
  • Fax: 304-845-9540
Mailing address:
  • Phone: 304-845-9550
  • Fax: 304-845-9540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2463
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: