Lacey Buchholtz
Individual provider Active NPI Physical Therapy Assistant · Augusta, WI
NPI 1043618580 · NPPES record last updated Mar 26, 2020
Key facts
- NPI
- 1043618580
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- 2212-19 (WI)
- Practice address
- 708 W Washington St
Augusta, WI 54722-9085 - Phone
- (715) 286-2488
- NPI assigned
- Dec 16, 2014
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2212-19 | WI | MD | Physical Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 2212-19 | WI | Yes |
Addresses
Primary practice location
708 W Washington St
Augusta, WI 54722-9085
Mailing address
708 W Washington St
Augusta, WI 54722-9085
Phone (715) 286-2488
Other practice location 1
s9969 WI-27
Augusta, WI 54722
Phone (715) 286-2266
Other providers in Augusta, WI
- Carol Ann Anger Culliton
- Augusta Area Home, Inc
- Augusta Chiropractic LLC
- Augusta School District
- Mackenzie Rose Bauer
- Christman Family Dental SC
- Jordan Doyle
- Brian Evans
- Savannah L Gray
- Kayla M Hickok
All providers in Augusta, WI · Physical Therapy Assistant in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 26, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.