Lacey Antonio, PTA

NPI #1679233100 in Leesburg, Georgia

Provider Information

NPI Number: 1679233100
Entity Type: Individual
Name: Lacey Antonio, PTA
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Physical Therapy Assistant
Credential: PTA
Enumeration Date: Dec 24, 2021
Last Updated: Dec 24, 2021

Practice Location

Address: 1360 LOVERS LANE RD
City: Leesburg
State: Georgia
ZIP Code: 31763-4544
Phone: (229) 881-2594

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapy Assistant	225200000X	Primary

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