Provider Demographics
NPI:1487319018
Name:NUGENT, LACIE (DPT)
Entity type:Individual
Prefix:
First Name:LACIE
Middle Name:
Last Name:NUGENT
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 1:7716 HICKORY GROVE LOOP
Mailing Address - Street 2:
Mailing Address - City:DEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71328-8211
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7716 HICKORY GROVE LOOP
Practice Address - Street 2:
Practice Address - City:DEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71328-8211
Practice Address - Country:US
Practice Address - Phone:318-792-7162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist