Provider Demographics
NPI:1649606906
Name:LUCE, MITCHELL ALLEN (DPT)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:ALLEN
Last Name:LUCE
Suffix:
Gender:M
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:PO BOX 1234
Mailing Address - Street 2:224 CASTLE AVE
Mailing Address - City:WINTHROP
Mailing Address - State:WA
Mailing Address - Zip Code:98862
Mailing Address - Country:US
Mailing Address - Phone:425-941-9957
Mailing Address - Fax:
Practice Address - Street 1:4719 272ND AVE NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98053
Practice Address - Country:US
Practice Address - Phone:425-941-9957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2644225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist