Individual
GAYNA GEORGETTE LACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
13946 BALTIMORE AVE, LAUREL, MD 20707-5000
(301) 498-2212
(301) 498-2213
Mailing address
PO BOX 4058, CROFTON, MD 21114-4058
(410) 315-9080
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
22170
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22170
PT LICENSE
MD
01
—
F8710017
CAREFIRST BLUE CROSS BLUE SHIELD
DC
Enumeration date
05/31/2007
Last updated
07/03/2019
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