Provider Demographics
NPI:1124168323
Name:LUCAS, KEVIN JOSEPH (LMT, CSIP)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:JOSEPH
Last Name:LUCAS
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Gender:M
Credentials:LMT, CSIP
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Other - First Name:
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Mailing Address - Street 1:12615 E MISSION AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1047
Mailing Address - Country:US
Mailing Address - Phone:509-891-2368
Mailing Address - Fax:509-891-2368
Practice Address - Street 1:12615 E MISSION AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1047
Practice Address - Country:US
Practice Address - Phone:509-891-2368
Practice Address - Fax:509-891-2368
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist