Provider Demographics
NPI:1790386688
Name:KANG, LUCY JUNE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:JUNE
Last Name:KANG
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4608 REUNION DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3811
Mailing Address - Country:US
Mailing Address - Phone:817-913-4304
Mailing Address - Fax:
Practice Address - Street 1:4608 REUNION DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3811
Practice Address - Country:US
Practice Address - Phone:817-913-4304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1337429225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist