Provider Demographics
NPI:1013565530
Name:PENNINGTON, LACIE (DPT)
Entity Type:Individual
Prefix:
First Name:LACIE
Middle Name:
Last Name:PENNINGTON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:LACIE
Other - Middle Name:
Other - Last Name:WEBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6501 HARRIS PKWY
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-6102
Mailing Address - Country:US
Mailing Address - Phone:817-370-9891
Mailing Address - Fax:
Practice Address - Street 1:6501 HARRIS PKWY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-6102
Practice Address - Country:US
Practice Address - Phone:817-370-9891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1323923OtherPT LICENSE
TX1323923OtherPT LICENSE