Provider Demographics
NPI:1740461243
Name:LUCAS, SUSAN TERESA (PT)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:TERESA
Last Name:LUCAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 263
Mailing Address - Street 2:668 TITICUS ROAD
Mailing Address - City:NORTH SALEM
Mailing Address - State:NY
Mailing Address - Zip Code:10560-0263
Mailing Address - Country:US
Mailing Address - Phone:914-669-5156
Mailing Address - Fax:914-277-7022
Practice Address - Street 1:1 GENEVA RD
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-2339
Practice Address - Country:US
Practice Address - Phone:845-278-6558
Practice Address - Fax:845-278-6026
Is Sole Proprietor?:No
Enumeration Date:2007-11-26
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005495-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist