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General NPI Number Information
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NPI Number | 1962539338
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Entity Type | Individual
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Provider Name | LACEY LEANN WESTON LPTA
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Gender | Female
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 08/09/2022
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Provider Practice Location Address
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Address Line | 889 EAST MAIN ST.
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City | MELBOURNE
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State | AR
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Zip | 72556
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Country | US
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Telephone | 870-368-4586
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Fax | 870-368-4587
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Provider Business Mailing Address
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Address Line | P.O. BOX 134
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City | SAGE
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State | AR
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Zip | 72573
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Country | US
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Telephone | 870-291-0361
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2053
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License Number State | AR
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