Provider Demographics
NPI:1104290311
Name:LUCERO, CHEREE LEE
Entity type:Individual
Prefix:
First Name:CHEREE
Middle Name:LEE
Last Name:LUCERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 N 20TH ST
Mailing Address - Street 2:APT J1036
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056-1445
Mailing Address - Country:US
Mailing Address - Phone:360-789-2970
Mailing Address - Fax:
Practice Address - Street 1:13050 MILITARY RD S
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98168-3047
Practice Address - Country:US
Practice Address - Phone:206-248-3080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-26
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist