Healthcare Provider Details

I. General information

NPI: 1528035045
Provider Name (Legal Business Name): ELIZABETH M LACY P.T., DPT, OCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH K MCKINZIE PT, DPT, OCS

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1185 W CARMEL DR BLDG C
CARMEL IN
46032-8708
US

IV. Provider business mailing address

1185 W CARMEL DR BLDG C
CARMEL IN
46032-8708
US

V. Phone/Fax

Practice location:
  • Phone: 317-582-8924
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number05007206A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: