Healthcare Provider Details

I. General information

NPI: 1619405156
Provider Name (Legal Business Name): LESLEY SHEELEY MAZICK PT, DPT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LESLEY SHEELEY

II. Dates (important events)

Enumeration Date: 05/29/2017
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4319 HARTLEY BRIDGE RD STE 150
MACON GA
31216-5866
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
HOOVER AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 479-333-5111
  • Fax:
Mailing address:
  • Phone: 423-238-7217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2021013332
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT014655
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT003322
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: