Provider Demographics
NPI:1134755267
Name:LUCAS, ROSALIE MARGARET (PT)
Entity type:Individual
Prefix:
First Name:ROSALIE
Middle Name:MARGARET
Last Name:LUCAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ROSALIE
Other - Middle Name:MARGARET
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2404 S LOCUST ST STE 5
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-5789
Mailing Address - Country:US
Mailing Address - Phone:575-521-4188
Mailing Address - Fax:575-521-3668
Practice Address - Street 1:1181 MALL DR STE C
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8105
Practice Address - Country:US
Practice Address - Phone:575-522-3316
Practice Address - Fax:575-522-4659
Is Sole Proprietor?:No
Enumeration Date:2020-03-20
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPT5568225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM2857OtherNM PT LICENSE