Individual
MRS. LACEY ANN GRACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
24 OLD ETNA RD, LEBANON, NH 03766-1937
(603) 442-4207
(603) 442-4250
Mailing address
130 JAMES ST, CHARLESTOWN, NH 03603-4716
(603) 826-5702
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
0845
NH
Other
Enumeration date
07/31/2007
Last updated
07/31/2007
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