Individual
MR. JACOB MATTHEW LUCAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPTA
Contact information
Practice address
2091 ASHLEIGH RD, BLACKVILLE, SC 29817-4551
(803) 571-0266
Mailing address
2091 ASHLEIGH RD, BLACKVILLE, SC 29817-4551
(803) 571-0266
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2452
SC
Other
Enumeration date
04/02/2018
Last updated
04/02/2018
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