Active NPI
Lacy Rae Phillips, PTA
- Geriatric Physical Therapist
- Omaha, NE
National Provider Identifier
1487214391
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Physical Therapist
- License
- 1106
- Practice address
- 4102 Woolworth Ave
Omaha, NE 68105-1851 - Phone
- (402) 444-7000
- NPI assigned
- Jun 13, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Geriatric Physical Therapist | 2251G0304X | 1106 | NE | Primary |
Addresses
Primary practice location
4102 Woolworth Ave
Omaha, NE 68105-1851
Mailing address
4733 S Ranch Cir
Blair, NE 68008-6436
Phone (712) 314-1681
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1106 | NE | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1560384000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560384000000",
"number": "1487214391",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4733 S RANCH CIR",
"city": "BLAIR",
"state": "NE",
"postal_code": "680086436",
"telephone_number": "712-314-1681"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4102 WOOLWORTH AVE",
"city": "OMAHA",
"state": "NE",
"postal_code": "681051851",
"telephone_number": "402-444-7000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHILLIPS",
"first_name": "LACY",
"middle_name": "RAE",
"name_prefix": "Miss",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-06-13",
"last_updated": "2019-06-13",
"status": "A"
},
"taxonomies": [
{
"code": "2251G0304X",
"taxonomy_group": "",
"desc": "Physical Therapist, Geriatrics",
"state": "NE",
"license": "1106",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Omaha, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.