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Organization
MID-OHIO VALLEY PHYSICAL MEDICINE
Active
Organization
MID-OHIO VALLEY PHYSICAL MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID WILLIAM LACEY M.D. (PRESIDENT)
(740) 376-5044
Entity
Organization
Contact information
Practice address
400 MATTHEW STREET, SUITE 306, MARIETTA, OH 45750
(740) 376-5044
(740) 374-1792
Mailing address
400 MATTHEW STREET, SUITE 306, MARIETTA, OH 45750
(740) 376-5044
(740) 374-1792
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
35066931L
OH
2081P0004X
Spinal Cord Injury Medicine Physician
35066931L
OH
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
35066931L
OH
2084N0600X
Clinical Neurophysiology Physician
35066931L
OH
Other
Enumeration date
05/03/2007
Last updated
07/17/2007
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