Provider Demographics
NPI:1245247493
Name:LUCAS, RIVES L
Entity type:Individual
Prefix:
First Name:RIVES
Middle Name:L
Last Name: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 1:1823 E GREENVILLE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-2048
Mailing Address - Country:US
Mailing Address - Phone:864-261-3313
Mailing Address - Fax:864-261-3371
Practice Address - Street 1:1823 E GREENVILLE ST
Practice Address - Street 2:SUITE A
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-2048
Practice Address - Country:US
Practice Address - Phone:864-261-3313
Practice Address - Fax:864-261-3371
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5332225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP1753Medicaid
SC426567Medicare ID - Type Unspecified