Provider Demographics
NPI:1497217830
Name:MCMURTREY, LACY JILL (PT, DPT)
Entity Type:Individual
Prefix:
First Name:LACY
Middle Name:JILL
Last Name:MCMURTREY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-2429
Mailing Address - Country:US
Mailing Address - Phone:432-267-3806
Mailing Address - Fax:432-267-3809
Practice Address - Street 1:306 W 3RD ST
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-2429
Practice Address - Country:US
Practice Address - Phone:432-267-3806
Practice Address - Fax:432-267-3809
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1305209208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00L09GOtherBCBS TEXAS
TX021635001Medicaid