Provider Demographics
NPI:1598193427
Name:LACEK, CHRISTINA VICTORIA TOKICS (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:VICTORIA TOKICS
Last Name:LACEK
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 1:17405 LAKEVIEW CT
Mailing Address - Street 2:
Mailing Address - City:UMATILLA
Mailing Address - State:FL
Mailing Address - Zip Code:32784-8379
Mailing Address - Country:US
Mailing Address - Phone:352-516-0724
Mailing Address - Fax:
Practice Address - Street 1:437 WEST ARDICE AVE
Practice Address - Street 2:SUITE 481
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726
Practice Address - Country:US
Practice Address - Phone:352-516-0724
Practice Address - Fax:352-771-2527
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-01
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 28522225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009954000Medicaid