Individual
PHILLIP BRANDON LACKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1112 MS-25, AMORRY, MS 38821
(662) 257-4048
Mailing address
1112 MS-25, AMORRY, MS 38821
(662) 257-4048
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA4680
MS
225200000X
Physical Therapy Assistant
PTA6336
AL
2255A2300X
Athletic Trainer
2373
AL
2255A2300X
Athletic Trainer
AT0358
MS
Other
Enumeration date
02/23/2021
Last updated
02/23/2021
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