Provider Demographics
NPI:1942010707
Name:LUCAS, TRACY (LMT)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:LUCAS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 COOPER ST APT 201
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-7065
Mailing Address - Country:US
Mailing Address - Phone:843-419-0561
Mailing Address - Fax:
Practice Address - Street 1:114 COOPER ST APT 201
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-7065
Practice Address - Country:US
Practice Address - Phone:843-419-0561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13565225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist