Provider Demographics
NPI:1942769385
Name:NOLAN, LUCY JO (LICENSED PT)
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:JO
Last Name:NOLAN
Suffix:
Gender:F
Credentials:LICENSED PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 LYNBROOK DR
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-4642
Mailing Address - Country:US
Mailing Address - Phone:301-996-9648
Mailing Address - Fax:
Practice Address - Street 1:8001 LYNBROOK DR
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4642
Practice Address - Country:US
Practice Address - Phone:301-240-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-15
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15130225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist