Provider Demographics
NPI:1376628362
Name:HIGGINS, LACEY M (PT)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:M
Last Name:HIGGINS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LACEY
Other - Middle Name:M
Other - Last Name:FEHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:221 SPENCER RD
Mailing Address - Street 2:STE D
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-2438
Mailing Address - Country:US
Mailing Address - Phone:636-477-9911
Mailing Address - Fax:636-477-9929
Practice Address - Street 1:221 SPENCER RD
Practice Address - Street 2:SUITE D
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-2438
Practice Address - Country:US
Practice Address - Phone:636-447-9911
Practice Address - Fax:636-477-9929
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2015-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO223461511Medicare PIN
MO223461509Medicare PIN