Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 070017504 | IL |
NPI | 1003161951 |
---|---|
Provider Name | Rebecca Elizabeth Lucas |
First Address | Ottawa, IL 61350-1275 |
Second Address | Streator, IL 61364-3332 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2012 |
Last Update Date | 17/07/2012 |