Provider Demographics
NPI:1073143707
Name:LUCAS, KERRY (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:
Last Name:LUCAS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 HARRODSBURG RD STE C55
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-1793
Mailing Address - Country:US
Mailing Address - Phone:859-313-1699
Mailing Address - Fax:859-313-3097
Practice Address - Street 1:1401 HARRODSBURG RD STE C55
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-1793
Practice Address - Country:US
Practice Address - Phone:859-313-1699
Practice Address - Fax:859-313-3097
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY004957225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist