Provider Demographics
NPI:1275913600
Name:KREFT, LACEY (DPT)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:
Last Name:KREFT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9178 HIGHLAND RD
Mailing Address - Street 2:STE 2
Mailing Address - City:WHITE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48386-4619
Mailing Address - Country:US
Mailing Address - Phone:248-698-1277
Mailing Address - Fax:248-698-2089
Practice Address - Street 1:9178 HIGHLAND RD
Practice Address - Street 2:STE 2
Practice Address - City:WHITE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48386-4619
Practice Address - Country:US
Practice Address - Phone:248-698-1277
Practice Address - Fax:248-698-2089
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501016626225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist