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NPI Code Detail

MEDICARE: MR. HAROLD LUCAS

MEDICARE: MR. HAROLD LUCAS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist2011037091MO

General Provider Information

NPI Number : 1306274386
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. HAROLD LUCAS
Provider Business Mailing Address
First Line : 1413 BALLARD ST
Second Line :
City : KENNETT
State : MO
Zip : 63857-1503
Country : US
Telephone Number : 310-951-2443
Fax Number :
Provider Business Practice Location Address
First Line : 500 BARRETT DR
Second Line :
City : MALDEN
State : MO
Zip : 63863-1204
Country : US
Telephone Number : 573-276-3843
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/29/2013
Last Update Date : 10/29/2013

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Directions to “ MR. HAROLD LUCAS ” Practice Location

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