Individual
CODY ALEXANDER LUCAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MT
Contact information
Practice address
767 W NORTH ST, FAYETTEVILLE, AR 72701-1865
(479) 387-7854
Mailing address
1572 N DAWN DR, FAYETTEVILLE, AR 72703-6093
(479) 387-7854
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
8920
AR
Other
Enumeration date
03/25/2021
Last updated
03/25/2021
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