Provider Demographics
NPI:1053953612
Name:LUCZON, NATALIE (LMT)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:LUCZON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 OKI PL
Mailing Address - Street 2:
Mailing Address - City:KAUNAKAKAI
Mailing Address - State:HI
Mailing Address - Zip Code:96748
Mailing Address - Country:US
Mailing Address - Phone:808-660-2595
Mailing Address - Fax:808-553-5194
Practice Address - Street 1:30 OKI PL
Practice Address - Street 2:
Practice Address - City:KAUNAKAKAI
Practice Address - State:HI
Practice Address - Zip Code:96748
Practice Address - Country:US
Practice Address - Phone:808-660-2595
Practice Address - Fax:808-553-5194
Is Sole Proprietor?:No
Enumeration Date:2019-10-15
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI13703225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist