Nathanael Lucero

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1267787 Issued in TX

Practice address

111 S Pine St
Roanoke, TX 76262-6638

Phone

(530) 902-1239

NPI assigned

Jun 3, 2024

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Foundation Therapy LLC

  • Physical Therapy Clinic/Center
  • Bridgeport, TX
  • NPI 1225446669
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1717372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717372800000",
    "number": "1457192791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 S PINE ST",
            "city": "ROANOKE",
            "state": "TX",
            "postal_code": "762626638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 S PINE ST",
            "city": "ROANOKE",
            "state": "TX",
            "postal_code": "762626638",
            "telephone_number": "530-902-1239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUCERO",
        "first_name": "NATHANAEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-06-03",
        "last_updated": "2024-06-03",
        "certification_date": "2024-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1267787",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anna Listmann, CCC-SLP
• Trenton Perry Little, DC
• Living Free Counseling, PLLC
• Kenneth W Locker, ATC
• Shelley Lynn Long, PH.D.
• Gueorgui T Maltchev, PA
• Mary Maltchev
• Nikitha Mantha
• Zachary Wade Marshall, M.D.
• Edward A Martinez, PA

• Physical Therapist in Roanoke, TX
• Providers in Roanoke, TX by specialty
• Physical Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.