Individual
MISS LACY RAE PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
4102 WOOLWORTH AVE, OMAHA, NE 68105-1851
(402) 444-7000
Mailing address
4733 S RANCH CIR, BLAIR, NE 68008-6436
(712) 314-1681
Taxonomy
Speciality
Code
Description
License number
State
2251G0304X
Geriatric Physical Therapist
Primary
1106
NE
Other
Enumeration date
06/13/2019
Last updated
06/13/2019
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