Individual
LUCAS DUTIL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
474 WILLIAM CAMPBELL DR, GLADYS, VA 24554-3204
(434) 841-5619
Mailing address
1800 COLBY DR, FOREST, VA 24551-1872
(802) 498-8278
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0126002777
VA
Other
Enumeration date
09/05/2017
Last updated
09/05/2017
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