Individual
KURTIS LACKLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT
Contact information
Practice address
3075 TOWER RD, SUITE A, COLUMBUS, GA 31909-2536
(706) 507-3794
(706) 507-3681
Mailing address
850 N HOSPITAL DR, SUITE H, FULTON, MO 65251-2535
(573) 642-8541
(573) 642-8500
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
2009028456
MO
225100000X
Physical Therapist
Primary
PT011452
GA
Other
Enumeration date
09/18/2009
Last updated
07/21/2015
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