Provider Demographics
NPI:1093190126
Name:LUCAS, EMILY (PT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:LUCAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:ROSE
Other - Last Name:DENARDIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:350 NEW FIDELITY CT
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2665
Mailing Address - Country:US
Mailing Address - Phone:919-258-2714
Mailing Address - Fax:410-648-4878
Practice Address - Street 1:2960 CHAIN BRIDGE RD
Practice Address - Street 2:STE 201
Practice Address - City:OAKTON
Practice Address - State:VA
Practice Address - Zip Code:22124-3039
Practice Address - Country:US
Practice Address - Phone:703-242-3460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-30
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305209643225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist