Provider Demographics
NPI:1417128729
Name:LUCAS, RAYMONDA KAY (LMT)
Entity Type:Individual
Prefix:
First Name:RAYMONDA
Middle Name:KAY
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 1:2806 W UPSHUR AVE
Mailing Address - Street 2:
Mailing Address - City:GLADEWATER
Mailing Address - State:TX
Mailing Address - Zip Code:75647-4246
Mailing Address - Country:US
Mailing Address - Phone:904-844-1759
Mailing Address - Fax:
Practice Address - Street 1:2806 W UPSHUR AVE
Practice Address - Street 2:
Practice Address - City:GLADEWATER
Practice Address - State:TX
Practice Address - Zip Code:75647-4246
Practice Address - Country:US
Practice Address - Phone:904-844-1759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT038313225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist