Provider Demographics
NPI:1457473886
Name:CAIN, LUCILLE ANN (PTA)
Entity Type:Individual
Prefix:MS
First Name:LUCILLE
Middle Name:ANN
Last Name:CAIN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 COUNTY ROAD 6510
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TX
Mailing Address - Zip Code:77535-3252
Mailing Address - Country:US
Mailing Address - Phone:937-371-2234
Mailing Address - Fax:
Practice Address - Street 1:700 COLORADO BLVD # 318
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-4084
Practice Address - Country:US
Practice Address - Phone:303-339-7408
Practice Address - Fax:866-293-4719
Is Sole Proprietor?:No
Enumeration Date:2007-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2049275225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant