Provider Demographics
NPI:1861598799
Name:LUCCI, BETH MARIE (PT)
Entity type:Individual
Prefix:MS
First Name:BETH
Middle Name:MARIE
Last Name:LUCCI
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 1:2873 OAKBROOK DR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33332-3415
Mailing Address - Country:US
Mailing Address - Phone:954-989-7002
Mailing Address - Fax:
Practice Address - Street 1:875 RETREAT DR
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-7927
Practice Address - Country:US
Practice Address - Phone:239-594-0877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT16899225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU1713ZMedicare ID - Type Unspecified