Provider Demographics
NPI:1528212677
Name:MACLUCAS, KATHRYN LEE (ATC, LAT)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:LEE
Last Name:MACLUCAS
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-4451
Mailing Address - Country:US
Mailing Address - Phone:423-483-3058
Mailing Address - Fax:
Practice Address - Street 1:4180 WEAVER PIKE
Practice Address - Street 2:SULLIVAN EAST HIGH SCHOOL
Practice Address - City:BLUFF CITY
Practice Address - State:TN
Practice Address - Zip Code:37618-2031
Practice Address - Country:US
Practice Address - Phone:423-416-2121
Practice Address - Fax:423-354-1906
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10402255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer