Provider Demographics
NPI:1265039184
Name:POINDEXTER, LUCERO (PTA)
Entity Type:Individual
Prefix:
First Name:LUCERO
Middle Name:
Last Name:POINDEXTER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6310 E AYRSHIRE CIR
Mailing Address - Street 2:
Mailing Address - City:CAMBY
Mailing Address - State:IN
Mailing Address - Zip Code:46113-9647
Mailing Address - Country:US
Mailing Address - Phone:910-527-1307
Mailing Address - Fax:
Practice Address - Street 1:4851 TINCHER RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46221-3780
Practice Address - Country:US
Practice Address - Phone:317-856-4851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-04
Last Update Date:2020-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06005588A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty