Provider Demographics
NPI:1609265396
Name:LAWALL-LUCAS, DENISE
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:LAWALL-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 1:1424 S OAK RD
Mailing Address - Street 2:
Mailing Address - City:FEASTERVILLE TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-4411
Mailing Address - Country:US
Mailing Address - Phone:215-499-5922
Mailing Address - Fax:
Practice Address - Street 1:1424 S OAK RD
Practice Address - Street 2:
Practice Address - City:FEASTERVILLE TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-4411
Practice Address - Country:US
Practice Address - Phone:215-499-5922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-18
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT005321L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist