Lacey Gostony, D.P.T. – Physical Therapist

Key facts

NPI: 1700319142
Entity type: Individual (NPI type 1)
Primary specialty: Physical Therapist 225100000X
License: PT42771 (CA)
Practice address: 1057 Foothill Blvd
La Canada, CA 91011-3249
Phone: (818) 864-6732
NPI assigned: Apr 4, 2017
Sex: Female
Sole proprietor: No

Organizations & group practices 1

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.

Foothill Family Service - Hudson Mental Health Clinic/Center (Including Community Mental Health Center) · Pasadena, CA · NPI 1336275056

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): Yes

State licenses

License	State	Type	Specialty
PT42771	CA	MD	Physical Therapist

Practice roles

Organization	Specialty	Status	New patients
Foothill Family Service - Hudson		Past since Aug 1, 2018	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Physical Therapist	225100000X	PT42771	CA	Yes

Addresses

Primary practice location

1057 Foothill Blvd
La Canada, CA 91011-3249

Mailing address

253 N Michigan Ave Apt 3
Pasadena, CA 91106-5172
Phone (626) 365-3219

Other identifiers

Identifier	Type	State	Issuer
PT42771	Other	CA	PHYSICAL THERAPIST LICENSE

Other providers in La Canada, CA

All providers in La Canada, CA · Physical Therapist in California

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 4, 2017. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.