Individual
SHELBY MARIE LUCUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1200 E PECAN ST, ALTUS, OK 73521-6141
(580) 379-5820
Mailing address
1200 E PECAN ST, ALTUS, OK 73521-6141
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2777
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201100700A
—
OK
Enumeration date
07/14/2017
Last updated
11/21/2023
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