Provider Demographics
NPI:1972104081
Name:LUCAS, VICTORIA RENEE (MT, HHWC, CHT, RM)
Entity type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:RENEE
Last Name:LUCAS
Suffix:
Gender:
Credentials:MT, HHWC, CHT, RM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 SETTLERS RIDGE PKWY UNIT C219
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55129-7521
Mailing Address - Country:US
Mailing Address - Phone:651-338-4869
Mailing Address - Fax:
Practice Address - Street 1:2550 HORIZON DR
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-3091
Practice Address - Country:US
Practice Address - Phone:651-338-4869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-04
Last Update Date:2025-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNTM15-13279225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist