Lacey J Phelan, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

13045 Issued in MT

Practice address

107 Ridgewater Dr Ste B
Polson, MT 59860-8977

Phone

(406) 883-2666

Fax

(406) 883-2667

NPI assigned

Feb 18, 2020

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• St Lukes Community Hospital

  • Rural Health Clinic/Center
  • Polson, MT
  • NPI 1548612096
  NPD (past)

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

{
    "created_epoch": "1581984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581984000000",
    "number": "1508499658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 6TH AVE SW",
            "city": "RONAN",
            "state": "MT",
            "postal_code": "598642634",
            "telephone_number": "406-676-4441",
            "fax_number": "406-676-0835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 RIDGEWATER DR STE B",
            "city": "POLSON",
            "state": "MT",
            "postal_code": "598608977",
            "telephone_number": "406-883-2666",
            "fax_number": "406-883-2667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHELAN",
        "first_name": "LACEY",
        "middle_name": "J",
        "name_prefix": "Ms.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-18",
        "last_updated": "2020-02-18",
        "certification_date": "2020-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MT",
            "license": "13045",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "medicalrecords@stldirect.org",
            "affiliation": "N",
            "address_1": "107 Ridgewater Dr Ste B",
            "city": "Polson",
            "state": "MT",
            "country_code": "US",
            "postal_code": "598608977",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Amy Gail Parsons, MA., CCC-SLP
• Shania Monique Patacsil, SWLC
• Leslie Anne Patterson, PTA
• Jedidiah Allen Petersen, PA
• Susan M Peterson, R.N.
• Richard Pierre, CPHT
• Malgorzata Podraza, O.D.
• Polson Ambulance, Inc.
• Polson Chiropractic LLC
• Polson Family Chiropractic Inc.

• Physical Therapist in Polson, MT
• Providers in Polson, MT by specialty
• Physical Therapist in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.