Individual
JASON LUCAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
516 EASTWAY DR, CHARLOTTE, NC 28205-1421
(980) 636-4426
Mailing address
PO BOX 912, FORT MILL, SC 29716-0912
(980) 636-4426
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
12413
SC
225700000X
Massage Therapist
19490
NC
Other
Enumeration date
10/11/2021
Last updated
10/11/2021
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