Provider Demographics
NPI:1538401021
Name:LUCIO, LAUREN KRYSTAL (DPT)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:KRYSTAL
Last Name:LUCIO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:KRYSTAL
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2525 N GRANDVIEW AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-1600
Mailing Address - Country:US
Mailing Address - Phone:432-550-4700
Mailing Address - Fax:432-550-4715
Practice Address - Street 1:2525 N GRANDVIEW AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-1600
Practice Address - Country:US
Practice Address - Phone:432-550-4700
Practice Address - Fax:432-550-4715
Is Sole Proprietor?:No
Enumeration Date:2013-03-22
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2091639225200000X
TX3123434225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3123434OtherTEXAS PHYSICAL THERAPY LICENSE