Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist |
NPI | 1740215813 |
---|---|
Provider Name | Mr. Michael Thomas Lacey |
First Address | New Castle, PA 16101-6286 |
Second Address | Hubbard, OH 44425-1750 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 08/07/2007 |