Provider Demographics
NPI:1659824001
Name:LUCERO, AUNDREA VANESSA (DPT)
Entity Type:Individual
Prefix:MRS
First Name:AUNDREA
Middle Name:VANESSA
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 1:1250 W ALYS PL
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80223-2733
Mailing Address - Country:US
Mailing Address - Phone:720-435-3088
Mailing Address - Fax:
Practice Address - Street 1:1250 W ALYS PL
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80223-2733
Practice Address - Country:US
Practice Address - Phone:720-435-3088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0014277225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist