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General NPI Number Information
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NPI Number | 1194949107
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Entity Type | Individual
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Provider Name | DELAINA LUCUS LPTA
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Gender | Female
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 711 AVIGNON DR
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City | RIDGELAND
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State | MS
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Zip | 39157-5120
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Country | US
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Telephone | 601-605-6777
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Fax | 601-605-8869
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Provider Business Mailing Address
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Address Line | 510 N 38TH AVE APT 59
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City | HATTIESBURG
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State | MS
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Zip | 39401-5732
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Country | US
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Telephone | 601-296-0411
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA2694
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License Number State | MS
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