Healthcare Provider Details

I. General information

NPI: 1023246618
Provider Name (Legal Business Name): LACY D JENNINGS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: LACY D BOGOSLAWSKY PT

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 S COLORADO BLVD
DENVER CO
80222-3303
US

IV. Provider business mailing address

1108 DRESSER CT SUITE 201B
RALEIGH NC
27609-7328
US

V. Phone/Fax

Practice location:
  • Phone: 303-394-3356
  • Fax:
Mailing address:
  • Phone: 919-876-8302
  • Fax: 919-954-8706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPTL.0012620
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12122
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: