Individual
LACEY ANTONIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1360 LOVERS LANE RD, LEESBURG, GA 31763-4544
(229) 881-2594
Mailing address
1360 LOVERS LANE RD, LEESBURG, GA 31763-4544
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Enumeration date
12/24/2021
Last updated
12/24/2021
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