Healthcare Provider Details

I. General information

NPI: 1740215813
Provider Name (Legal Business Name): MICHAEL THOMAS LACEY R.K.T., C.S.C.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 W LIBERTY ST
HUBBARD OH
44425-1750
US

IV. Provider business mailing address

106 LINKS DR
NEW CASTLE PA
16101-6286
US

V. Phone/Fax

Practice location:
  • Phone: 330-534-8500
  • Fax: 330-534-3926
Mailing address:
  • Phone: 724-674-6109
  • Fax: 330-534-9632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: