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General NPI Number Information
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NPI Number | 1376340398
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Entity Type | Individual
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Provider Name | KEVIN LUCAS PT
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Gender | Male
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Dates
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Enumeration Date | 02/27/2025
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Last Update Date | 02/27/2025
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Provider Practice Location Address
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Address Line | 2331 FRANKLIN RD SW
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City | ROANOKE
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State | VA
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Zip | 24014-1111
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Country | US
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Telephone | 540-981-8050
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Fax |
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Provider Business Mailing Address
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Address Line | 3600 RICHMOND LN APT B
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City | BLACKSBURG
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State | VA
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Zip | 24060-4374
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Country | US
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Telephone | 703-398-5923
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 23052114871
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License Number State | VA
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