Provider Demographics
NPI:1154786663
Name:LUCAS, KRISTIN (PT, DPT)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:LUCAS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-568-7043
Practice Address - Street 1:600 BROADWAY
Practice Address - Street 2:SUITE 580
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5229
Practice Address - Country:US
Practice Address - Phone:206-386-6229
Practice Address - Fax:206-386-6254
Is Sole Proprietor?:No
Enumeration Date:2015-12-28
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60357008225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist