Provider Demographics
NPI:1790071496
Name:GANN, LACEY A (DPT)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:A
Last Name:GANN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8955 HIGHWAY 6 N
Mailing Address - Street 2:SUITE 190
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-2320
Mailing Address - Country:US
Mailing Address - Phone:832-593-8600
Mailing Address - Fax:832-593-8601
Practice Address - Street 1:8955 HIGHWAY 6 N
Practice Address - Street 2:SUITE 190
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-2320
Practice Address - Country:US
Practice Address - Phone:832-593-8600
Practice Address - Fax:832-593-8601
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1197570225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist