Provider Demographics
NPI:1033108584
Name:LUCEY, MARIE (PT)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:LUCEY
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 1:255 GRAPEVINE RD
Mailing Address - Street 2:
Mailing Address - City:WENHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01984
Mailing Address - Country:US
Mailing Address - Phone:978-867-4095
Mailing Address - Fax:978-867-4680
Practice Address - Street 1:255 GRAPEVINE RD
Practice Address - Street 2:
Practice Address - City:WENHAM
Practice Address - State:MA
Practice Address - Zip Code:01984
Practice Address - Country:US
Practice Address - Phone:978-867-4095
Practice Address - Fax:978-867-4680
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5464225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY69257Medicare ID - Type Unspecified