Individual
LACEY MOODY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3964 GOODMAN RD E, SUITE 111, SOUTHAVEN, MS 38672-8761
(662) 890-6953
(662) 890-6954
Mailing address
2001 MALLORY LN, SUITE 201, FRANKLIN, TN 37067-8233
(615) 373-1350
(615) 221-9054
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT5426
MS
Other
Enumeration date
05/13/2014
Last updated
05/13/2014
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