MEDICARE: MR. VINCENT E LUCAS LMT, MMP

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
1	225700000X	Massage Therapist	8133	NC

General Provider Information

NPI Number	:	1629367248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. VINCENT E LUCAS LMT, MMP

Provider Business Mailing Address
First Line	:	7825 ARBORETUM DR
Second Line	:	201
City	:	CHARLOTTE
State	:	NC
Zip	:	28270-0323
Country	:	US
Telephone Number	:	704-905-0104
Fax Number	:

Provider Business Practice Location Address
First Line	:	447 S SHARON AMITY RD
Second Line	:	225
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-2836
Country	:	US
Telephone Number	:	704-905-0104
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2011
Last Update Date	:	04/05/2011

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