MEDICARE: LETICIA A CAMPOS-LUCIO LPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1066181	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8T7655	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1003828658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LETICIA A CAMPOS-LUCIO LPT

Provider Business Mailing Address
First Line	:	PO BOX 451261
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78045-0031
Country	:	US
Telephone Number	:	956-722-0200
Fax Number	:	956-722-0611

Provider Business Practice Location Address
First Line	:	4151 BOB BULLOCK
Second Line	:	STE 208
City	:	LAREDO
State	:	TX
Zip	:	78043-4741
Country	:	US
Telephone Number	:	956-722-0200
Fax Number	:	956-722-0611

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	05/02/2008

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Directions to “ LETICIA A CAMPOS-LUCIO LPT” Practice Location

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