Active NPI
Christopher J. Lacy, P.T.A.
- Physical Therapy Assistant
- Lake City, FL
National Provider Identifier
1609109446
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA 21841
- Practice address
- 146 SW Orthopedic CT
Lake City, FL 32024-0672 - Phone
- (386) 719-5100
- Fax
- (386) 719-5101
- NPI assigned
- Sep 11, 2009
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | PTA 21841 | FL | Primary |
Addresses
Primary practice location
146 SW Orthopedic CT
Lake City, FL 32024-0672
Mailing address
4500 W Newberry Rd
Gainesville, FL 32607-2245
Phone (352) 336-6000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PTA 21841 | Other | FL | PTA LICENSE |
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 |
|---|---|---|---|
| PTA 21841 | FL | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1252627200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1424304000000",
"number": "1609109446",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4500 W NEWBERRY RD",
"city": "GAINESVILLE",
"state": "FL",
"postal_code": "326072245",
"telephone_number": "352-336-6000",
"fax_number": "352-332-0799"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "146 SW ORTHOPEDIC CT",
"city": "LAKE CITY",
"state": "FL",
"postal_code": "320240672",
"telephone_number": "386-719-5100",
"fax_number": "386-719-5101"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LACY",
"first_name": "CHRISTOPHER",
"middle_name": "J.",
"credential": "P.T.A.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-09-11",
"last_updated": "2015-02-19",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "FL",
"license": "PTA 21841",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PTA LICENSE",
"identifier": "PTA 21841",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lake City, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.