Individual
RYAN A LUCAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
A.T.C.
Contact information
Practice address
100 FODEN RD, SUITE 103 WEST, SOUTH PORTLAND, ME 04106-2319
(207) 772-2625
Mailing address
69 EUCLID AVE, PORTLAND, ME 04103-1200
(207) 831-7540
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT190
ME
Other
Enumeration date
10/12/2005
Last updated
07/08/2007
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