# MID-OHIO VALLEY PHYSICAL MEDICINE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700098811
- **Authorized official:** DAVID WILLIAM LACEY M.D. (PRESIDENT)
- **Authorized official phone:** (740) 376-5044

## Contact information

- **Practice address:** 400 MATTHEW STREET, SUITE 306, MARIETTA, OH 45750
- **Practice address phone:** (740) 376-5044
- **Practice address fax:** (740) 374-1792
- **Mailing address:** 400 MATTHEW STREET, SUITE 306, MARIETTA, OH 45750
- **Mailing address phone:** (740) 376-5044
- **Mailing address fax:** (740) 374-1792

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | 35066931L | OH | Yes |
| 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