Provider Demographics
NPI:1366856999
Name:CAMPBELL, LACEY (PHYSICAL THERAPY ASS)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PHYSICAL THERAPY ASS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7402 WESTSHIRE DR STE 105
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-8687
Mailing Address - Country:US
Mailing Address - Phone:517-853-6800
Mailing Address - Fax:517-853-6801
Practice Address - Street 1:132 S CEDAR ST
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:MI
Practice Address - Zip Code:48854-2401
Practice Address - Country:US
Practice Address - Phone:517-853-6800
Practice Address - Fax:517-853-6801
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502004209225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant