Individual
LACEY LORAL ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
2685 PELHAM PKWY, SUITE C, PELHAM, AL 35124-1354
(205) 621-6503
(205) 621-6507
Mailing address
2685 PELHAM PKWY, SUITE C, PELHAM, AL 35124-1354
(205) 621-6503
(205) 621-6507
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
PT26720
FL
2251P0200X
Pediatric Physical Therapist
Primary
PTH6802
AL
Other
Enumeration date
07/11/2013
Last updated
12/05/2013
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