Individual
MRS. EILEEN JANIS LACKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
5535 PARK ST N, ST PETERSBURG, FL 33709-6309
(727) 209-0579
(727) 209-0580
Mailing address
6447 FAIRWAY VIEW BLVD S, ST PETERSBURG, FL 33707-3815
(727) 209-0579
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA18384
FL
Other
Enumeration date
05/31/2012
Last updated
05/31/2012
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