Individual
LACEY AUTUMN HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
4871 SOCASTEE BLVD UNIT E, MYRTLE BEACH, SC 29588-7252
(843) 293-5610
Mailing address
4871 SOCASTEE BLVD UNIT E, MYRTLE BEACH, SC 29588-7252
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
4887
SC
Other
Enumeration date
06/27/2022
Last updated
06/27/2022
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