Healthcare Provider Details

I. General information

NPI: 1376628362
Provider Name (Legal Business Name): LACEY M HIGGINS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LACEY M FEHL PT

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 12/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 SPENCER RD SUITE D
SAINT PETERS MO
63376-2438
US

IV. Provider business mailing address

221 SPENCER RD STE D
SAINT PETERS MO
63376-2438
US

V. Phone/Fax

Practice location:
  • Phone: 636-447-9911
  • Fax: 636-477-9929
Mailing address:
  • Phone: 636-477-9911
  • Fax: 636-477-9929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: