Provider Demographics
NPI:1164542668
Name:LUE, GRACE MARIA (PT)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:MARIA
Last Name:LUE
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 1:8494 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-4153
Mailing Address - Country:US
Mailing Address - Phone:305-261-9555
Mailing Address - Fax:305-261-0911
Practice Address - Street 1:8494 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4153
Practice Address - Country:US
Practice Address - Phone:305-261-9555
Practice Address - Fax:305-261-0911
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT4192225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE5381AOtherMEDICARE LEGACY
FLE5381AMedicare PIN