Provider Demographics
NPI:1407372725
Name:LUCAS-ROBINSON, JANE LOUISE (LMT)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:LOUISE
Last Name:LUCAS-ROBINSON
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 1:10831 SHELP LAKE DR
Mailing Address - Street 2:
Mailing Address - City:DELTON
Mailing Address - State:MI
Mailing Address - Zip Code:49046-9447
Mailing Address - Country:US
Mailing Address - Phone:269-664-6899
Mailing Address - Fax:
Practice Address - Street 1:7900 OWEN DR
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-9007
Practice Address - Country:US
Practice Address - Phone:269-903-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-17
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501001741225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist