MEDICARE: ROMMEL LACSON PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	05010457A	IN

General Provider Information

NPI Number	:	1023319381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROMMEL LACSON PT

Provider Business Mailing Address
First Line	:	2424 104TH AVE SE
Second Line	:
City	:	LAKE STEVENS
State	:	WA
Zip	:	98258-5655
Country	:	US
Telephone Number	:	425-280-7578
Fax Number	:

Provider Business Practice Location Address
First Line	:	2424 104TH AVE SE
Second Line	:
City	:	LAKE STEVENS
State	:	WA
Zip	:	98258-5655
Country	:	US
Telephone Number	:	425-280-7578
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2010
Last Update Date	:	11/03/2010

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Directions to “ ROMMEL LACSON PT” Practice Location

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