Provider Demographics
NPI:1477282630
Name:LUCERO, DEANNA (DPT)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:LUCERO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 SEVILLA AVE NW STE E
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-1853
Mailing Address - Country:US
Mailing Address - Phone:505-363-9582
Mailing Address - Fax:505-214-5137
Practice Address - Street 1:5400 SEVILLA AVE NW STE E
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-1853
Practice Address - Country:US
Practice Address - Phone:505-363-9582
Practice Address - Fax:505-214-5137
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-05
Last Update Date:2022-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPT6119225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty