Provider Demographics
NPI:1134324387
Name:LUCIER, ROGER H (PT)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:H
Last Name:LUCIER
Suffix:
Gender:M
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:PO BOX 2024
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-2024
Mailing Address - Country:US
Mailing Address - Phone:928-639-3068
Mailing Address - Fax:928-639-3346
Practice Address - Street 1:825 W MINGUS AVE
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4088
Practice Address - Country:US
Practice Address - Phone:928-639-3068
Practice Address - Fax:928-639-3346
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6598225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ915473Medicaid
AZZ101949Medicare PIN