Provider Demographics
NPI:1861554933
Name:CLINE, LACEY ANN (MPT)
Entity type:Individual
Prefix:MRS
First Name:LACEY
Middle Name:ANN
Last Name:CLINE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MS
Other - First Name:LACEY
Other - Middle Name:ANN
Other - Last Name:CASHDOLLAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:414 PENCO RD
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-3822
Mailing Address - Country:US
Mailing Address - Phone:304-723-3780
Mailing Address - Fax:
Practice Address - Street 1:414 PENCO RD
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-3822
Practice Address - Country:US
Practice Address - Phone:304-723-3780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV002590225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV4198122Medicare PIN
WV4198124Medicare PIN
WV4198123Medicare PIN