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Individual

LACY KISSELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1129 PARKWAY AVE, ELKHART, IN 46516-1395
(574) 498-3449
Mailing address
1801 BALTIC AVE, ELKHART, IN 46514-8361

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06005918A
IN

Other

Enumeration date
02/10/2026
Last updated
02/10/2026
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