Provider Demographics
NPI:1336398858
Name:SANCHEZ, LUCITO IGNACIO (RPT)
Entity Type:Individual
Prefix:
First Name:LUCITO
Middle Name:IGNACIO
Last Name:SANCHEZ
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17835 CLEVELAND RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635-1348
Mailing Address - Country:US
Mailing Address - Phone:574-271-8760
Mailing Address - Fax:
Practice Address - Street 1:17835 CLEVELAND RD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635-1348
Practice Address - Country:US
Practice Address - Phone:574-271-8760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50003039A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist