Individual
KACIE MARIE LUCKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
13151 DENHAM RD, BATON ROUGE, LA 70818-1202
(225) 939-2998
Mailing address
PO BOX 63, PRIDE, LA 70770-0063
(225) 939-2998
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A7620
LA
Other
Enumeration date
02/09/2010
Last updated
02/09/2010
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