Provider Demographics
NPI:1295968576
Name:HERRON, LACEY KATHERINE (PT,DPT)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:KATHERINE
Last Name:HERRON
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5710 HIDDEN RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6364
Mailing Address - Country:US
Mailing Address - Phone:225-931-5064
Mailing Address - Fax:
Practice Address - Street 1:28977 WALKER RD S STE G
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:LA
Practice Address - Zip Code:70785-6049
Practice Address - Country:US
Practice Address - Phone:225-271-8056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-02
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07606225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist