Provider Demographics
NPI:1306324223
Name:LACEY, NKEM L (PT, DPT)
Entity type:Individual
Prefix:
First Name:NKEM
Middle Name:L
Last Name:LACEY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:NKEM
Other - Middle Name:L
Other - Last Name:NKELE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:4455 MEDICAL CENTER WAY
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-3244
Mailing Address - Country:US
Mailing Address - Phone:561-881-0066
Mailing Address - Fax:561-881-5533
Practice Address - Street 1:4455 MEDICAL CENTER WAY
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-3244
Practice Address - Country:US
Practice Address - Phone:561-881-0066
Practice Address - Fax:561-881-5533
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT33735225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist