Healthcare Provider Details

I. General information

NPI: 1861396996
Provider Name (Legal Business Name): LAXMILAVANYA GULLAPALLI PT, DPT, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

928 COPPERFIELD BLVD NE
CONCORD NC
28025-2433
US

IV. Provider business mailing address

404 ALAMEDA WAY
MATTHEWS NC
28104-6148
US

V. Phone/Fax

Practice location:
  • Phone: 704-885-1447
  • Fax:
Mailing address:
  • Phone: 980-422-6922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6650
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP13539
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: