Provider Demographics
NPI:1083923627
Name:GALBRAITH, LACEY LYNN (PT)
Entity Type:Individual
Prefix:MRS
First Name:LACEY
Middle Name:LYNN
Last Name:GALBRAITH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 BLOOMENDAAL DR
Mailing Address - Street 2:
Mailing Address - City:IPSWICH
Mailing Address - State:SD
Mailing Address - Zip Code:57451
Mailing Address - Country:US
Mailing Address - Phone:605-426-6622
Mailing Address - Fax:605-426-6565
Practice Address - Street 1:617 BLOOMENDAAL DR
Practice Address - Street 2:
Practice Address - City:IPSWICH
Practice Address - State:SD
Practice Address - Zip Code:57451
Practice Address - Country:US
Practice Address - Phone:605-426-6622
Practice Address - Fax:605-426-6565
Is Sole Proprietor?:No
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1455225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist