Provider Demographics
NPI:1295846236
Name:LEGASPI, LUCIANO G (PT)
Entity Type:Individual
Prefix:
First Name:LUCIANO
Middle Name:G
Last Name:LEGASPI
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 1:320 KING OF PRUSSIA RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RADNOR
Mailing Address - State:PA
Mailing Address - Zip Code:19087-4440
Mailing Address - Country:US
Mailing Address - Phone:610-341-9100
Mailing Address - Fax:610-341-9993
Practice Address - Street 1:320 KING OF PRUSSIA RD
Practice Address - Street 2:SUITE 100
Practice Address - City:RADNOR
Practice Address - State:PA
Practice Address - Zip Code:19087-4440
Practice Address - Country:US
Practice Address - Phone:610-341-9100
Practice Address - Fax:610-341-9993
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT0139809L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA080491Medicare ID - Type Unspecified