Individual
MRS. LAGRETTA CHARVETTE STUCKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2415 PARKWOOD DR, BRUNSWICK, GA 31520-4722
(912) 466-2660
Mailing address
113 HIDDEN LAKES DR, BRUNSWICK, GA 31525-3049
(912) 264-9482
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
005504
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005504
PHYSICAL THERAPY
GA
Enumeration date
02/22/2007
Last updated
07/08/2007
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