Provider Demographics
NPI:1093580839
Name:LACY, GABBY BURMASTER
Entity Type:Individual
Prefix:
First Name:GABBY
Middle Name:BURMASTER
Last Name:LACY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 LEIGHTON AVE # B
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-5744
Mailing Address - Country:US
Mailing Address - Phone:256-235-2524
Mailing Address - Fax:256-236-2573
Practice Address - Street 1:626 LEIGHTON AVE # B
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-5744
Practice Address - Country:US
Practice Address - Phone:256-235-2524
Practice Address - Fax:256-236-2573
Is Sole Proprietor?:No
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH116092251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics