Provider Demographics
NPI:1154566909
Name:SKIBITSKY, LACEY K (DPT)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:K
Last Name:SKIBITSKY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LACEY
Other - Middle Name:S
Other - Last Name:GARVIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:134 GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-1338
Mailing Address - Country:US
Mailing Address - Phone:303-902-3481
Mailing Address - Fax:
Practice Address - Street 1:134 GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-1338
Practice Address - Country:US
Practice Address - Phone:303-902-3481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-09
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP14135225100000X
PAPT019522225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2123171OtherHIGHMARK PA BLUE SHIELD
PA3744639000OtherIBC
PA1154566909OtherUNISON
PA30068872OtherKEYSTONE MERCY
PA102376562-0001Medicaid
1154566909OtherBRAVO
PA161238VLZMedicare PIN