Provider Demographics
NPI:1285984260
Name:LACEY, MICHELLE EILENE (DPT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:EILENE
Last Name:LACEY
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 1:13835 N TATUM BLVD STE 9442
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-5581
Mailing Address - Country:US
Mailing Address - Phone:480-666-6020
Mailing Address - Fax:480-666-6074
Practice Address - Street 1:9040 FRIARS RD STE 400
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-5862
Practice Address - Country:US
Practice Address - Phone:619-284-6377
Practice Address - Fax:619-241-7581
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34387225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist