Provider Demographics
NPI:1356696777
Name:GROARK, LACEY LEIGH (DPT)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:LEIGH
Last Name:GROARK
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 1:838 SCARSDALE AVE
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-5318
Mailing Address - Country:US
Mailing Address - Phone:914-722-9200
Mailing Address - Fax:914-922-9201
Practice Address - Street 1:7 POPHAM RD
Practice Address - Street 2:SUITE 302
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-3709
Practice Address - Country:US
Practice Address - Phone:914-722-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0351181225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist