Provider Demographics
NPI:1295845774
Name:LACY, EDWARD F (PT CSCS)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:F
Last Name:LACY
Suffix:
Gender:M
Credentials:PT CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 E SILVER SPRINGS BLVD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-3228
Mailing Address - Country:US
Mailing Address - Phone:352-236-1811
Mailing Address - Fax:
Practice Address - Street 1:4901 E SILVER SPRINGS BLVD
Practice Address - Street 2:STE 305
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-3228
Practice Address - Country:US
Practice Address - Phone:352-263-1811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL195282251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic