Provider Demographics
NPI:1104369412
Name:SIKULA, LACEY NOELLE (DPT)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:NOELLE
Last Name:SIKULA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LACEY
Other - Middle Name:NOELLE
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1574 HABRA CT
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-3144
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2189 EASTMAN AVE
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-5792
Practice Address - Country:US
Practice Address - Phone:805-639-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38764225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist