Provider Demographics
NPI:1326276734
Name:LUCIER, ANGELA JOSEPHINE (DPT)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:JOSEPHINE
Last Name:LUCIER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2041 MESA VALLEY WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-6828
Mailing Address - Country:US
Mailing Address - Phone:678-309-8159
Mailing Address - Fax:678-309-8158
Practice Address - Street 1:2041 MESA VALLEY WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-6828
Practice Address - Country:US
Practice Address - Phone:678-309-8159
Practice Address - Fax:678-309-8158
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010179225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist