Individual
LACEY MCROY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
070020112
IL
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
070020112
IL
225100000X
Physical Therapist
Primary
13273
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
070020112
—
IL
Enumeration date
09/10/2013
Last updated
01/12/2016
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