Provider Demographics
NPI:1821300104
Name:LUCENO, KENT (PT)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:
Last Name:LUCENO
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 1:1258 WOODSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-1911
Mailing Address - Country:US
Mailing Address - Phone:718-232-2300
Mailing Address - Fax:718-236-3449
Practice Address - Street 1:5911 16TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-2114
Practice Address - Country:US
Practice Address - Phone:718-232-2300
Practice Address - Fax:718-236-3449
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-02
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029167225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist