MEDICARE: MR. ROBERT CECIL LAC,PTA

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	225200000X	Physical Therapy Assistant	A03453	KY
2	171100000X	Acupuncturist	AC128	KY

General Provider Information

NPI Number	:	1942731179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT CECIL LAC,PTA

Provider Business Mailing Address
First Line	:	225 SAINT JOHN RD
Second Line	:
City	:	ELIZABETHTOWN
State	:	KY
Zip	:	42701-2918
Country	:	US
Telephone Number	:	270-769-3314
Fax Number	:

Provider Business Practice Location Address
First Line	:	3044 RING RD
Second Line	:
City	:	ELIZABETHTOWN
State	:	KY
Zip	:	42701-7932
Country	:	US
Telephone Number	:	270-506-3853
Fax Number	:

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

Provider Enumeration Date	:	03/21/2017
Last Update Date	:	02/05/2020

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