Provider Demographics
NPI:1720112469
Name:LACEY, PATRICIA A (PTA)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:A
Last Name:LACEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 SW 39TH ST
Mailing Address - Street 2:APT #313
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-2401
Mailing Address - Country:US
Mailing Address - Phone:954-696-5501
Mailing Address - Fax:
Practice Address - Street 1:1830 NW 122ND TER
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-1966
Practice Address - Country:US
Practice Address - Phone:954-435-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19188225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant