Provider Demographics
NPI:1326119082
Name:LUCAS, PETRA H (LMT)
Entity Type:Individual
Prefix:
First Name:PETRA
Middle Name:H
Last Name:LUCAS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1788 CLOVER CIR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-5582
Mailing Address - Country:US
Mailing Address - Phone:321-242-4861
Mailing Address - Fax:321-242-4861
Practice Address - Street 1:3084 LAKE WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32934-7613
Practice Address - Country:US
Practice Address - Phone:321-259-5056
Practice Address - Fax:321-259-5057
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA20910225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist