Provider Demographics
NPI:1801308572
Name:BROWN, LACY (PT, DPT)
Entity type:Individual
Prefix:
First Name:LACY
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:LACY
Other - Middle Name:
Other - Last Name:WILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:4727 42ND AVE SW APT 420
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-4267
Mailing Address - Country:US
Mailing Address - Phone:253-348-9697
Mailing Address - Fax:
Practice Address - Street 1:1058 E MERCER ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-5032
Practice Address - Country:US
Practice Address - Phone:253-348-9697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist