Provider Demographics
NPI:1851402317
Name:LUCCHESI, DOROTHY IRENE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:IRENE
Last Name:LUCCHESI
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:IRENE
Other - Last Name:MCGRAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:301 VISTA SUERTE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-3516
Mailing Address - Country:US
Mailing Address - Phone:949-760-9545
Mailing Address - Fax:
Practice Address - Street 1:2600 EAST PACIFIC COAST HIGHWAY
Practice Address - Street 2:SUITE 240
Practice Address - City:CORONA DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92625
Practice Address - Country:US
Practice Address - Phone:949-760-9545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT3766225100000X, 2251E1200X, 2251G0304X, 2251H1200X, 2251S0007X, 2251X0800X, 225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251E1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistErgonomics
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ55488ZOtherBLUE SHIELD PROVIDER ID
CAZZZ55488ZOtherBLUE SHIELD PROVIDER ID
CAR37065Medicare UPIN