Basic Information
| Provider Information | |||||||||
| NPI: | 1275295297 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | LUCAS | ||||||||
| FirstName: | LAURA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 277 RHODES RD | ||||||||
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| City: | APALACHIN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 137322637 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 220 STEUBEN ST | ||||||||
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| City: | MONTOUR FALLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 148659709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6075357121 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2021 | ||||||||
| LastUpdateDate: | 10/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 047707-01 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.