Provider Demographics
NPI:1265256671
Name:HENRY, LACIE SUE (DPT)
Entity type:Individual
Prefix:
First Name:LACIE
Middle Name:SUE
Last Name:HENRY
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 1:14190 ORCHARD PKWY STE 250
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80023-9708
Mailing Address - Country:US
Mailing Address - Phone:720-497-6666
Mailing Address - Fax:720-497-6777
Practice Address - Street 1:14190 ORCHARD PKWY STE 250
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80023-9708
Practice Address - Country:US
Practice Address - Phone:720-497-6666
Practice Address - Fax:720-497-6777
Is Sole Proprietor?:No
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20231225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist