Individual
MATTIE ANNE LUCAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
23 W GLANN RD, APALACHIN, NY 13732-4026
(607) 725-0889
Mailing address
43 FENTON AVE, BINGHAMTON, NY 13901-1738
(607) 725-0430
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
007988
NY
Other
Enumeration date
07/07/2017
Last updated
07/07/2017
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