Provider Demographics
NPI:1275919235
Name:LUCHERINI, NATHAN (DPT)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:LUCHERINI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12518 NE AIRPORT WAY
Mailing Address - Street 2:STE 110
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-1078
Mailing Address - Country:US
Mailing Address - Phone:503-256-2992
Mailing Address - Fax:503-258-0717
Practice Address - Street 1:12518 NE AIRPORT WAY
Practice Address - Street 2:STE 110
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-1078
Practice Address - Country:US
Practice Address - Phone:503-256-2992
Practice Address - Fax:503-258-0717
Is Sole Proprietor?:No
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR61095225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist