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Individual

MELANIE RAE LUCK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
ATC

Contact information

Practice address
14311 COMPTON VILLAGE DR, CENTREVILLE, VA 20121-5702
(703) 424-1423
Mailing address
14311 COMPTON VILLAGE DR, CENTREVILLE, VA 20121-5702
(703) 424-1423

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2000024698
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
R50971758
BLUE CROSS BLUE SHIELD
VA
Enumeration date
11/03/2016
Last updated
11/03/2016
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