Individual
LACY PENWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1675 NE LOOP 286, PARIS, TX 75460-2219
(903) 782-9922
Mailing address
303 COUNTY ROAD 44750, BLOSSOM, TX 75416-3916
(903) 905-0499
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2136091
TX
Other
Enumeration date
08/31/2018
Last updated
08/31/2018
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