Active NPI
Michael Hautea Lucero, P.T.
- Physical Therapist
- Winston Salem, NC
National Provider Identifier
1710182068
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 9853
- Practice address
- 1000 Salemtowne Dr
Winston Salem, NC 27106-3294 - Phone
- (336) 776-2300
- NPI assigned
- Jun 18, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 9853 | NC | Primary |
Addresses
Primary practice location
1000 Salemtowne Dr
Winston Salem, NC 27106-3294
Mailing address
PO Box 1301
Clemmons, NC 27012-1301
Phone (478) 737-8726
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9853 | NC | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182124800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1710182068",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1301",
"city": "CLEMMONS",
"state": "NC",
"postal_code": "270121301",
"telephone_number": "478-737-8726"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 SALEMTOWNE DR",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271063294",
"telephone_number": "336-776-2300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUCERO",
"first_name": "MICHAEL",
"middle_name": "HAUTEA",
"name_prefix": "Mr.",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-06-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NC",
"license": "9853",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winston Salem, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.