Provider Demographics
NPI:1811287980
Name:LUCIDO-CLAY, MONICA M (PT)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:M
Last Name:LUCIDO-CLAY
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 1:701 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78401-3420
Mailing Address - Country:US
Mailing Address - Phone:361-879-0006
Mailing Address - Fax:361-879-0702
Practice Address - Street 1:701 PARK AVE
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78401-3420
Practice Address - Country:US
Practice Address - Phone:361-879-0006
Practice Address - Fax:361-879-0702
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1200770225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist