Provider Demographics
NPI:1346609187
Name:LU, LACE A (PT)
Entity Type:Individual
Prefix:
First Name:LACE
Middle Name:A
Last Name:LU
Suffix:
Gender:F
Credentials:PT
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Mailing Address - Street 1:24630 WASHINGTON AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-6131
Mailing Address - Country:US
Mailing Address - Phone:951-696-9353
Mailing Address - Fax:951-973-7216
Practice Address - Street 1:73345 HIGHWAY 111
Practice Address - Street 2:SUITE 103
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-3909
Practice Address - Country:US
Practice Address - Phone:760-674-0675
Practice Address - Fax:760-674-0645
Is Sole Proprietor?:No
Enumeration Date:2016-02-22
Last Update Date:2016-04-19
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Provider Licenses
StateLicense IDTaxonomies
CA291218225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA193231Medicare PIN