Individual
AMANDA LYNN LUCY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT DPT
Contact information
Practice address
577 E ELDER ST, SUITE I, FALLBROOK, CA 92028-3079
(760) 723-2687
(760) 723-2689
Mailing address
407 GRAND VISTA LN, FALLBROOK, CA 92028-8912
(661) 400-2951
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT36082
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P01453008
RR MEDICARE
CA
Enumeration date
11/02/2009
Last updated
09/10/2019
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