Basic Information
| Provider Information | |||||||||
| NPI: | 1922386796 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LUCAS | ||||||||
| FirstName: | ERICKA | ||||||||
| MiddleName: | IRENE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PT, DPT, OCS | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BRESKE | ||||||||
| OtherFirstName: | ERICKA | ||||||||
| OtherMiddleName: | IRENE | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PT, DPT, OCS | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 750 HOSPITAL LOOP | ||||||||
| Address2: | |||||||||
| City: | CRAIG | ||||||||
| State: | CO | ||||||||
| PostalCode: | 816258750 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9708249411 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 473 YAMPA AVE | ||||||||
| Address2: | |||||||||
| City: | CRAIG | ||||||||
| State: | CO | ||||||||
| PostalCode: | 816252657 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9708245992 | ||||||||
| FaxNumber: | 9708245994 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2011 | ||||||||
| LastUpdateDate: | 08/11/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 11339 | CO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.