Provider Demographics
NPI:1881949121
Name:CUMO, LACIE RENEE (PT)
Entity type:Individual
Prefix:
First Name:LACIE
Middle Name:RENEE
Last Name:CUMO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LACIE
Other - Middle Name:RENEE
Other - Last Name:MORORRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5300 DERRY ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-3576
Mailing Address - Country:US
Mailing Address - Phone:717-839-2110
Mailing Address - Fax:717-565-1934
Practice Address - Street 1:9613 LINCOLN HWY
Practice Address - Street 2:SUITE 107
Practice Address - City:BEDFORD
Practice Address - State:PA
Practice Address - Zip Code:15522-3748
Practice Address - Country:US
Practice Address - Phone:814-623-1042
Practice Address - Fax:814-623-1044
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT020395225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist