Provider Demographics
NPI:1841668043
Name:KREACHBAUM, LACY (LMT)
Entity type:Individual
Prefix:
First Name:LACY
Middle Name:
Last Name:KREACHBAUM
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1662 S DEFRAME ST UNIT B8
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-6018
Mailing Address - Country:US
Mailing Address - Phone:720-425-8615
Mailing Address - Fax:
Practice Address - Street 1:1662 S DEFRAME ST UNIT B8
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-6018
Practice Address - Country:US
Practice Address - Phone:720-425-8615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-04
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0016520225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist