Provider Demographics
NPI:1336268978
Name:LUCIDO, MELANIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:
Last Name:LUCIDO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9413 TRAIL HILL DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-1437
Mailing Address - Country:US
Mailing Address - Phone:972-386-6310
Mailing Address - Fax:972-404-9150
Practice Address - Street 1:12890 HILLCREST RD
Practice Address - Street 2:SUITE 201
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1504
Practice Address - Country:US
Practice Address - Phone:972-386-6310
Practice Address - Fax:972-404-9150
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1044960174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX571156586OtherTAX ID