Healthcare Provider Details

I. General information

NPI: 1902720444
Provider Name (Legal Business Name): LACEY LESLIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 DRIFTING WIND RUN STE 111
DRIPPING SPRINGS TX
78620-5629
US

IV. Provider business mailing address

174 EL CAPITAN LOOP
DRIPPING SPRINGS TX
78620-3035
US

V. Phone/Fax

Practice location:
  • Phone: 512-693-2062
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: