Provider Demographics
NPI:1730366568
Name:MERVINE, LUCRECIA L (PT)
Entity type:Individual
Prefix:
First Name:LUCRECIA
Middle Name:L
Last Name:MERVINE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4946 STEELHEAD ST
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-8728
Mailing Address - Country:US
Mailing Address - Phone:814-242-9062
Mailing Address - Fax:
Practice Address - Street 1:9109 MENDENHALL MALL RD
Practice Address - Street 2:SUITE 5K
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-7136
Practice Address - Country:US
Practice Address - Phone:814-242-9062
Practice Address - Fax:907-789-5577
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist