Provider Demographics
NPI:1821290693
Name:MUNOZ, LACEY LOU (DPT)
Entity Type:Individual
Prefix:DR
First Name:LACEY
Middle Name:LOU
Last Name:MUNOZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:LACEY
Other - Middle Name:LOU
Other - Last Name:HUFF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:339 WASHO DR
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-5134
Mailing Address - Country:US
Mailing Address - Phone:707-972-1773
Mailing Address - Fax:
Practice Address - Street 1:404 E PERKINS ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-4507
Practice Address - Country:US
Practice Address - Phone:707-463-7346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30212225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist