MEDICARE: MRS. MONICA LACY PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	PT00276R	LA

General Provider Information

NPI Number	:	1922267400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MONICA LACY PT

Provider Business Mailing Address
First Line	:	2463 VANCEVILLE RD
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-6313
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2463 VANCEVILLE RD
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-6313
Country	:	US
Telephone Number	:	318-746-8482
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2008
Last Update Date	:	06/09/2008

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