Individual
LACEY SIMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1000 N ALLEN ST, ROBINSON, IL 62454-1114
(618) 546-2695
Mailing address
1000 N ALLEN ST, ROBINSON, IL 62454-1114
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160005581
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
160005581
STATE LICENSE
IL
Enumeration date
04/09/2019
Last updated
04/09/2019
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