MEDICARE: JORGESON F LUCERO PT

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
2	225100000X	Physical Therapist	1385892	TX

General Provider Information

NPI Number	:	1366217333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORGESON F LUCERO PT

Provider Business Mailing Address
First Line	:	1110 KINGWOOD DR STE 245
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77339-3099
Country	:	US
Telephone Number	:	832-292-7679
Fax Number	:

Provider Business Practice Location Address
First Line	:	1306 KINGWOOD DR STE E
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77339-3150
Country	:	US
Telephone Number	:	281-721-4023
Fax Number	:

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

Provider Enumeration Date	:	11/20/2023
Last Update Date	:	10/24/2024

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Directions to “ JORGESON F LUCERO PT” Practice Location

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