Individual
BRIAN MICHAEL LACKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T,
Contact information
Practice address
924 PLANTATION BLVD STE B, FAIRHOPE, AL 36532-7308
(251) 928-0600
(251) 928-6137
Mailing address
164 PECAN AVE, FAIRHOPE, AL 36532-1226
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PTH2793
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51098701
BCBS PROVIDER NUMBER
AL
Enumeration date
10/05/2005
Last updated
10/05/2018
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