=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366797508
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LACEY J SINNETT DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2012
-----------------------------------------------------
Last Update Date | 11/15/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2455 SW STATE ST
-----------------------------------------------------
City | ANKENY
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50023-1277
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-963-4528
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2455 SW STATE ST
-----------------------------------------------------
City | ANKENY
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50023-1277
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-963-4528
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 05010842A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT872523
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | CP033196T
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------