Individual
KELLY PAYNE LUCAS I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2501 DOWNING ST SW, WILSON, NC 27893-4517
(252) 237-6300
Mailing address
2501 DOWNING ST SW, WILSON, NC 27893-4517
(252) 237-6300
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1110
NC
Other
Enumeration date
09/04/2019
Last updated
09/04/2019
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