Individual
MISS LACEY M RUNYON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DAT, LAT, ATC
Contact information
Practice address
100 N EAST AVE, WAUKESHA, WI 53186-3103
(262) 524-7202
Mailing address
7100 ASHWOOD LN, WATERFORD, WI 53185-2170
(219) 863-9119
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36001401A
IN
Other
Enumeration date
04/17/2006
Last updated
05/09/2023
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