| NPI | 1023246618 |
|---|---|
| Former Name | LACY D BOGOSLAWSKY |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CO PTL.0012620) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 12122) |
| Enumeration Date | 2009-06-23 |
| Last Update Date | 2025-10-13 |