Individual
MR. STACEY WADE GANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPTA
Contact information
Practice address
201 OFFICE PARK DR STE 150, MOUNTAIN BRK, AL 35223-2400
(205) 879-6447
(205) 278-2299
Mailing address
201 OFFICE PARK DR STE 150, MOUNTAIN BRK, AL 35223-2400
(205) 278-2250
(205) 278-2299
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA8197
AL
Other
Enumeration date
12/16/2016
Last updated
12/16/2016
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