MEDICARE: ALEXIS LACEY SAMS DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	8881	SC
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1861901183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS LACEY SAMS DPT

Provider Business Mailing Address
First Line	:	PO BOX 306393
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37230-6393
Country	:	US
Telephone Number	:	615-373-1350
Fax Number	:	615-373-7116

Provider Business Practice Location Address
First Line	:	3879 W ASHLEY CIR UNIT 700
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29414-9272
Country	:	US
Telephone Number	:	843-628-0121
Fax Number	:	843-628-0124

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2017
Last Update Date	:	07/19/2024

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