Provider Demographics
NPI:1912261199
Name:LUCAS, MALEE V (LMT)
Entity Type:Individual
Prefix:MS
First Name:MALEE
Middle Name:V
Last Name:LUCAS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1718 NE 11TH AVE APT 207
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-4072
Mailing Address - Country:US
Mailing Address - Phone:503-816-3890
Mailing Address - Fax:
Practice Address - Street 1:2390 NW THURMAN ST # 1
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2521
Practice Address - Country:US
Practice Address - Phone:503-816-3890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12182225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist