Provider Demographics
NPI:1285325050
Name:LUCERO, KIRI LYNN (LMT)
Entity type:Individual
Prefix:
First Name:KIRI
Middle Name:LYNN
Last Name:LUCERO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5252 E 111TH PL
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80233-3820
Mailing Address - Country:US
Mailing Address - Phone:720-998-3869
Mailing Address - Fax:
Practice Address - Street 1:2008 W 120TH AVE STE B
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-2446
Practice Address - Country:US
Practice Address - Phone:303-920-2350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0020710225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist