Provider Demographics
NPI:1245568807
Name:PARCO, LUCIO (RPT)
Entity Type:Individual
Prefix:
First Name:LUCIO
Middle Name:
Last Name:PARCO
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 LAKEBRIDGE PLAZA DR APT 311
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5158
Mailing Address - Country:US
Mailing Address - Phone:904-347-1015
Mailing Address - Fax:
Practice Address - Street 1:420 LAKEBRIDGE PLAZA DR APT 311
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5158
Practice Address - Country:US
Practice Address - Phone:904-347-1015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8991225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist