Provider Demographics
NPI:1023248010
Name:HALE, LACEY (DPT)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:
Last Name:HALE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13610 ROUTE H
Mailing Address - Street 2:
Mailing Address - City:HENLEY
Mailing Address - State:MO
Mailing Address - Zip Code:65040-2133
Mailing Address - Country:US
Mailing Address - Phone:573-645-8118
Mailing Address - Fax:
Practice Address - Street 1:3308 W EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-6891
Practice Address - Country:US
Practice Address - Phone:573-638-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-23
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009019831225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist