Provider Demographics
NPI:1144798828
Name:LUCAS, CHELSEA NICOLE (PT, DPT, CMTPT)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:NICOLE
Last Name:LUCAS
Suffix:
Gender:F
Credentials:PT, DPT, CMTPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 CALMES ST
Mailing Address - Street 2:
Mailing Address - City:CHARLES TOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25414-5397
Mailing Address - Country:US
Mailing Address - Phone:443-897-9621
Mailing Address - Fax:
Practice Address - Street 1:525 E MARKET ST STE B
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-4171
Practice Address - Country:US
Practice Address - Phone:703-443-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-11
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPT004395225100000X
SCPT.9410225100000X
VACP015738T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist