MEDICARE: LUCITO IGNACIO SANCHEZ RPT

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	50003039A	IN

General Provider Information

NPI Number	:	1336398858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCITO IGNACIO SANCHEZ RPT

Provider Business Mailing Address
First Line	:	17835 CLEVELAND RD
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46635-1348
Country	:	US
Telephone Number	:	574-271-8760
Fax Number	:

Provider Business Practice Location Address
First Line	:	17835 CLEVELAND RD
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46635-1348
Country	:	US
Telephone Number	:	574-271-8760
Fax Number	:

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

Provider Enumeration Date	:	09/09/2008
Last Update Date	:	09/09/2008

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