Healthcare Provider Details

I. General information

NPI: 1023573771
Provider Name (Legal Business Name): LACY MCMAHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2019
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 18TH ST SE
HICKORY NC
28602-1363
US

IV. Provider business mailing address

4601 PARK RD STE 300
CHARLOTTE NC
28209-2290
US

V. Phone/Fax

Practice location:
  • Phone: 828-485-2160
  • Fax:
Mailing address:
  • Phone: 828-485-2160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP18613
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: