Provider Demographics
NPI:1629523691
Name:LUCAS, CAITLIN KIEVENAAR (PT, DPT, MS, ATC)
Entity Type:Individual
Prefix:DR
First Name:CAITLIN
Middle Name:KIEVENAAR
Last Name:LUCAS
Suffix:
Gender:F
Credentials:PT, DPT, MS, ATC
Other - Prefix:DR
Other - First Name:CAITLIN
Other - Middle Name:JEAN
Other - Last Name:KIEVENAAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, MS, ATC
Mailing Address - Street 1:20925 PROFESSIONAL PLZ STE 110
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-3403
Mailing Address - Country:US
Mailing Address - Phone:703-723-6758
Mailing Address - Fax:
Practice Address - Street 1:20925 PROFESSIONAL PLZ STE 110
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-3403
Practice Address - Country:US
Practice Address - Phone:303-279-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-19
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0014321225100000X
VA2305211593225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist