Individual
MR. STACY RYAN LUCAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPTA, LMT
Contact information
Practice address
1000 LINCOLN DR, SOUTH CHARLESTON, WV 25309-2304
(304) 768-4400
Mailing address
1000 LINCOLN DR, SOUTH CHARLESTON, WV 25309-2304
(304) 768-4400
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
000627
WV
Other
Enumeration date
11/11/2007
Last updated
11/11/2007
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