Provider Demographics
NPI:1659048106
Name:LACEY, TIARA JAQUESE (PT, DPT)
Entity type:Individual
Prefix:
First Name:TIARA
Middle Name:JAQUESE
Last Name:LACEY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:TIARA
Other - Middle Name:
Other - Last Name:HOWTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:
Practice Address - Street 1:2910 MORGAN RD
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022-6484
Practice Address - Country:US
Practice Address - Phone:205-230-0400
Practice Address - Fax:205-623-3892
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH10512225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist