MS. LACEY WISE (PT) – Physical Therapist, NPI 1154830677
Physical Therapist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
3,527 PHYSICAL THERAPIST IN PRIVATE PRACTICE in WA
Provider Addresses for MS. LACEY WISE (PT)
1817 S Market Blvd Ste C
Chehalis, WA 985324100
Phone: (360) 996-4410
Fax: (360) 996-4466
Type: Location
36th Avenue Northeast, Salem, Marion County, Oregon, 97310, United States
SALEM, OR 973014741
Phone: (503) 371-8860
Type: Mailing
1817 S MARKET BLVD STE C
CHEHALIS, WA 985324100
Phone: (360) 996-4410
Fax: (360) 996-4466
Type: Mailing
1316 MT SAINT HELENS WAY SE
SUITE B
CASTLE ROCK, WA 98611
Phone: (360) 557-8020
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2023-08-11
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20230811002140 | I | Physical Therapist In Private Practice | WA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 98532)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Physical Therapist In Private Practice | WA | |
| Physical Therapist In Private Practice | WA | |
| Physical Therapist In Private Practice | WA | |
| Physical Therapist In Private Practice | WA | |
| Physical Therapist In Private Practice | WA | |
| Physical Therapist In Private Practice | WA | |
| Physical Therapist In Private Practice | WA | |
| Physical Therapist In Private Practice | WA | |
| Physical Therapist In Private Practice | WA | |
| Physical Therapist In Private Practice | WA |
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