Provider Demographics
NPI:1982146270
Name:LUCAS EMG SPECIALISTS
Entity type:Organization
Organization Name:LUCAS EMG SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:540-772-8022
Mailing Address - Street 1:3241 ELECTRIC RD
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-6405
Mailing Address - Country:US
Mailing Address - Phone:540-772-8022
Mailing Address - Fax:
Practice Address - Street 1:109 KNOTBREAK RD
Practice Address - Street 2:STE 2
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-5404
Practice Address - Country:US
Practice Address - Phone:540-772-8022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LUCAS PHYSICAL THERAPY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-17
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurologyGroup - Single Specialty