Provider Demographics
NPI:1811313307
Name:LUCAS, CHRISTI LYNN (PTA)
Entity type:Individual
Prefix:MRS
First Name:CHRISTI
Middle Name:LYNN
Last Name:LUCAS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1528 FRIENDLY RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-5908
Mailing Address - Country:US
Mailing Address - Phone:410-371-5469
Mailing Address - Fax:410-437-6971
Practice Address - Street 1:1528 FRIENDLY RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-5908
Practice Address - Country:US
Practice Address - Phone:410-371-5469
Practice Address - Fax:410-437-6971
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-09
Last Update Date:2014-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA2401225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant