Individual
LUCAS J. GREGORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
002315
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000217253
ANTHEM BCBS
—
01
—
001720908
MOUNTAIN STATE BCBS
—
05
—
7302399000
—
WV
01
—
P00017315
RR MEDICARE
—
Enumeration date
07/13/2006
Last updated
08/08/2011
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