Individual
KELLY FROMM LUCAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
54 HOSPITAL DR, OSAGE BEACH, MO 65065-3050
(573) 374-8885
(573) 374-7566
Mailing address
23 SHERWOOD DR, CAMDENTON, MO 65020-2329
(573) 873-9503
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
117102
MO
Other
Enumeration date
03/19/2007
Last updated
07/08/2007
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