Provider Demographics
NPI:1437276441
Name:LUC, IRENE G (PT,DPT,OCS,NPS)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:G
Last Name:LUC
Suffix:
Gender:F
Credentials:PT,DPT,OCS,NPS
Other - Prefix:
Other - First Name:IRENE
Other - Middle Name:
Other - Last Name:CHOU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:602 N COLORADO ST
Mailing Address - Street 2:STE 110
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7825
Mailing Address - Country:US
Mailing Address - Phone:509-396-3707
Mailing Address - Fax:
Practice Address - Street 1:602 N COLORADO ST
Practice Address - Street 2:STE 110
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7825
Practice Address - Country:US
Practice Address - Phone:509-396-3707
Practice Address - Fax:509-396-3710
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60848501225100000X
MO2002007688225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist