Individual
MS. LACEY WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1316 MT SAINT HELENS WAY SE, SUITE B, CASTLE ROCK, WA 98611
(360) 557-8020
Mailing address
1817 S MARKET BLVD STE C, CHEHALIS, WA 98532-4100
(360) 996-4410
(360) 996-4466
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT61342050
WA
Other
Enumeration date
09/27/2017
Last updated
03/26/2024
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