Provider Demographics
NPI:1912796962
Name:LESUEUR, LACIE M (LMT)
Entity type:Individual
Prefix:MS
First Name:LACIE
Middle Name:M
Last Name:LESUEUR
Suffix:
Gender:
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 RIDGEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23661-1106
Mailing Address - Country:US
Mailing Address - Phone:850-814-5618
Mailing Address - Fax:
Practice Address - Street 1:633 INDEPENDENCE BLVD STE A
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-2200
Practice Address - Country:US
Practice Address - Phone:757-962-6191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019017594225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist