Individual
JENEVIEVE LACKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3919 SOUTH CAROLINA 14, GREENVILLE, SC 29615
(864) 252-9941
Mailing address
400 MILLS AVE UNIT 227, GREENVILLE, SC 29605-4184
(509) 420-3810
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9337
STATE LICENSURE
SC
Enumeration date
10/24/2018
Last updated
05/09/2025
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