Provider Demographics
NPI:1447802384
Name:LUCAS, CAROLYN
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:LUCAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12551 OLD GLENN HWY STE E
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7590
Mailing Address - Country:US
Mailing Address - Phone:907-694-5515
Mailing Address - Fax:907-694-5575
Practice Address - Street 1:12551 OLD GLENN HWY STE E
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7590
Practice Address - Country:US
Practice Address - Phone:907-694-5515
Practice Address - Fax:907-694-5575
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT027712225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist