Provider Demographics
NPI:1225784630
Name:LUCAS-ZIEMBA, MARY F (PT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:F
Last Name:LUCAS-ZIEMBA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 OLD ORCHARD LN
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-1394
Mailing Address - Country:US
Mailing Address - Phone:336-508-1430
Mailing Address - Fax:855-232-8604
Practice Address - Street 1:15 OLD ORCHARD LN
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-1394
Practice Address - Country:US
Practice Address - Phone:336-508-1430
Practice Address - Fax:855-232-8604
Is Sole Proprietor?:No
Enumeration Date:2022-02-24
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP4544225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist