Healthcare Provider Details

I. General information

NPI: 1740989961
Provider Name (Legal Business Name): LISA LASHANI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15825 BALLANTYNE MEDICAL PL STE 120
CHARLOTTE NC
28277-4790
US

IV. Provider business mailing address

PO BOX 601791
CHARLOTTE NC
28260-1791
US

V. Phone/Fax

Practice location:
  • Phone: 704-323-3409
  • Fax:
Mailing address:
  • Phone: 336-718-4820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP21958
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: