=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245750595
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KENDRA JACKALYN LUCAS PT, DPT, NBC-HWC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2017
-----------------------------------------------------
Last Update Date | 04/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 620 KLING DR
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45419-4201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-345-3483
-----------------------------------------------------
Fax | 877-865-9852
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 620 KLING DR
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45419-4201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-345-3483
-----------------------------------------------------
Fax | 877-865-9852
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171400000X
-----------------------------------------------------
Taxonomy Name | Health & Wellness Coach
-----------------------------------------------------
License Number | A-3887738
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT016767
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------