Provider Demographics
NPI:1649062563
Name:WILKINS, LACY LYNETTE
Entity type:Individual
Prefix:
First Name:LACY
Middle Name:LYNETTE
Last Name:WILKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LACY
Other - Middle Name:LYNETTE
Other - Last Name:CONNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3411 ACACIA GROVE LN
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-5056
Mailing Address - Country:US
Mailing Address - Phone:713-824-2302
Mailing Address - Fax:
Practice Address - Street 1:19298 W LAKE HOUSTON PKWY STE 240
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-4827
Practice Address - Country:US
Practice Address - Phone:832-828-4990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1349272225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist