Provider Demographics
NPI:1154345148
Name:TONNIGES, LACY (DPT)
Entity type:Individual
Prefix:
First Name:LACY
Middle Name:
Last Name:TONNIGES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1694 TOPAZ DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-3210
Mailing Address - Country:US
Mailing Address - Phone:970-593-9300
Mailing Address - Fax:970-593-9318
Practice Address - Street 1:1694 TOPAZ DR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-3210
Practice Address - Country:US
Practice Address - Phone:970-593-9300
Practice Address - Fax:970-593-9318
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8906225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC809026Medicare PIN