Provider Demographics
NPI:1467276691
Name:ROWE-LACKEY, BRIANA NICOLE (PTA)
Entity type:Individual
Prefix:
First Name:BRIANA
Middle Name:NICOLE
Last Name:ROWE-LACKEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11501 FLATWOODS RD
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TN
Mailing Address - Zip Code:37874-3600
Mailing Address - Country:US
Mailing Address - Phone:865-696-0284
Mailing Address - Fax:
Practice Address - Street 1:520 OLD HIGHWAY 68
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:TN
Practice Address - Zip Code:37874-6258
Practice Address - Country:US
Practice Address - Phone:423-351-1050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8799225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty