Lacey Wise, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT61342050 Issued in WA

Practice address

1316 Mt Saint Helens Way SE
Suite B
Castle Rock, WA 98611

Phone

(360) 557-8020

NPI assigned

Sep 27, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Centralia Physical Therapy Inc PSGroup PAC ID 0648429688, 20 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Centralia Physical Therapy Inc PS

  • Physical Therapist
  • Centralia, WA
  • NPI 1952666315
  Medicare reassignment Care Compare group NPD
• Aeroflow Connect LLC

  • Lactation Consultant (Non-RN)
  • Asheville, NC
  • NPI 1790306819
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1506470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711411200000",
    "number": "1154830677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1817 S MARKET BLVD STE C",
            "city": "CHEHALIS",
            "state": "WA",
            "postal_code": "985324100",
            "telephone_number": "360-996-4410",
            "fax_number": "360-996-4466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1316 MT SAINT HELENS WAY SE",
            "address_2": "SUITE B",
            "city": "CASTLE ROCK",
            "state": "WA",
            "postal_code": "98611",
            "telephone_number": "360-557-8020"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1817 S Market Blvd Ste C",
            "address_purpose": "LOCATION",
            "city": "Chehalis",
            "state": "WA",
            "postal_code": "985324100",
            "country_code": "US",
            "telephone_number": "360-996-4410",
            "fax_number": "360-996-4466",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WISE",
        "first_name": "LACEY",
        "name_prefix": "Ms.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-27",
        "last_updated": "2024-03-26",
        "certification_date": "2024-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT61342050",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emma V. Torres-Baltazar, MD
• Chuan Ching Tu
• Renee Amelia Walden, ARNP
• Marvin James Waletich, RPH
• Scott Wambold, LMT

• Physical Therapist in Castle Rock, WA
• Providers in Castle Rock, WA by specialty
• Physical Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.