Nicholas David Lacey, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

296330 Issued in CA

Practice address

1510 W Branch St
Arroyo Grande, CA 93420-1817

Phone

(805) 489-7912

Fax

(805) 489-9697

NPI assigned

Mar 17, 2019

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

State University of New York at Stony Brook, School of Medicine, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

MDRS Spine and Sport IncGroup PAC ID 3274446687, 181 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.

• MDRS Spine & Sport, Inc

  • Multi-Specialty Clinic/Center
  • San Diego, CA
  • NPI 1952394603

  Physical Therapist

  Medicare reassignment Care Compare group NPD
• California Luna Care Physical Therapy PC

  • Physical Therapist
  • Los Gatos, CA
  • NPI 1689162166
  Medicare reassignment NPD
• Proactive Physical Therapy & Sports Medicine Inc

  • Physical Therapy Clinic/Center
  • Carlsbad, CA
  • NPI 1285729509

  Physical Therapist

  Medicare reassignment NPD
• MDRS Spine & Sport, Inc

  • Physical Therapist
  • Temecula, CA
  • NPI 1689824203
  NPD
• San Luis Physical Therapy & Orthopedic Rehabilitation Inc

  • Physical Therapy Clinic/Center
  • Atascadero, CA
  • NPI 1225046824

  Physical Therapist

  NPD (past)
• San Luis Physical Therapy & Orthopedic Rehabilitation Inc

  • Physical Therapy Clinic/Center
  • Pismo Beach, CA
  • NPI 1235147828

  Physical Therapist

  NPD (past)
• DPT Holdings PLLC

  • Physical Therapist
  • Plainfield, IL
  • NPI 1689648602
  NPD (past)

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

{
    "created_epoch": "1552780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710115200000",
    "number": "1639638984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "408 HIGUERA ST STE 200",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934016135",
            "telephone_number": "805-788-0805",
            "fax_number": "805-788-0845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1510 W BRANCH ST",
            "city": "ARROYO GRANDE",
            "state": "CA",
            "postal_code": "934201817",
            "telephone_number": "805-489-7912",
            "fax_number": "805-489-9697"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2345 E 8th St",
            "address_purpose": "LOCATION",
            "city": "National City",
            "state": "CA",
            "postal_code": "919502800",
            "country_code": "US",
            "telephone_number": "619-323-2040",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LACEY",
        "first_name": "NICHOLAS",
        "middle_name": "DAVID",
        "credential": "PT, DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-03-17",
        "last_updated": "2024-03-11",
        "certification_date": "2024-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "296330",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "14366874",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hailey Kutch
• Robert Kvalstad, MD
• Kyle Moser DC LLC
• La Laser Center PC a Professional Medical Corporation
• Alyssa Labrado
• Tom Lachapelle
• Lags Spine and Sportscare Medical Center, Inc.
• Mollyo Landry -Brown, R.N.F.A.
• Larry Foreman, DO
• Brianna Larsen, LMFT

• Physical Therapist in Arroyo Grande, CA
• Providers in Arroyo Grande, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 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.