Individual
JENNIFER LACKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPT
Contact information
Practice address
109 MARTIN LUTHER KING JR DR, FORSYTH, GA 31029-1689
(478) 994-3390
(478) 845-6252
Mailing address
300 ROCKY CREEK CT, FORSYTH, GA 31029-5301
(478) 994-3390
(478) 845-6252
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT005260
GA
Other
Enumeration date
10/07/2015
Last updated
10/07/2015
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