Individual
CANDICE LACEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
806 W COLLEGE AVE, BERRYVILLE, AR 72616-3107
(870) 423-3124
Mailing address
2413 TURNER WAY, PEA RIDGE, AR 72751-2523
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
4270
AR
Other
Enumeration date
12/03/2024
Last updated
12/03/2024
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