Individual
BINTA LACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3750 OLD LEE HWY, FAIRFAX, VA 22030-1806
(703) 246-7160
Mailing address
4375 RALEIGH AVE APT 104, ALEXANDRIA, VA 22304-5355
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305204471
VA
Other
Enumeration date
07/30/2006
Last updated
07/08/2007
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