Individual
MATTHEW J LUCAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1917 N LAKEWOOD DR, COEUR D ALENE, ID 83814-2634
(208) 664-8194
(208) 667-1847
Mailing address
1917 N LAKEWOOD DR, COEUR D ALENE, ID 83814-2634
(208) 664-8194
(208) 667-1847
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-1931
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010150822
BLUE SHIELD
ID
01
—
0198312
LABOR AND INDUSTRY
WA
05
—
807206500
—
ID
01
—
TC811
BLUE CROSS
ID
Enumeration date
07/10/2006
Last updated
03/06/2009
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