Provider Demographics
NPI:1992231930
Name:SCHULTE, LACEY ANN (DPT)
Entity type:Individual
Prefix:MRS
First Name:LACEY
Middle Name:ANN
Last Name:SCHULTE
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 1:2004 TWIN CITY DR
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-3820
Mailing Address - Country:US
Mailing Address - Phone:701-667-0745
Mailing Address - Fax:701-667-0707
Practice Address - Street 1:1000 W CENTURY AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0913
Practice Address - Country:US
Practice Address - Phone:701-355-1294
Practice Address - Fax:701-323-7046
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2096225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist