Provider Demographics
NPI:1649645771
Name:LUCE, MICHAEL JOHN (LMT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOHN
Last Name:LUCE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6915 LAKEWOOD DR W STE A2
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98467-3299
Mailing Address - Country:US
Mailing Address - Phone:253-474-4226
Mailing Address - Fax:253-474-9040
Practice Address - Street 1:6915 LAKEWOOD DR W
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98467-3299
Practice Address - Country:US
Practice Address - Phone:253-474-4226
Practice Address - Fax:253-474-9040
Is Sole Proprietor?:No
Enumeration Date:2015-12-01
Last Update Date:2024-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60613605225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist