Provider Demographics
NPI:1407178304
Name:TROTH, LACEY ERIN (ATC)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:ERIN
Last Name:TROTH
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 S STAGE COACH LN
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-4429
Mailing Address - Country:US
Mailing Address - Phone:661-341-1040
Mailing Address - Fax:
Practice Address - Street 1:2400 S STAGE COACH LN
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028-4429
Practice Address - Country:US
Practice Address - Phone:661-341-1040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer