Individual
KELLIE LACEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.P.T.A.
Contact information
Practice address
31181 S JORDAN RD, LEBO, KS 66856-9130
(785) 242-1433
Mailing address
31181 S JORDAN RD, LEBO, KS 66856-9130
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
14-01693
KS
Other
Enumeration date
06/24/2010
Last updated
06/24/2010
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