Healthcare Provider Details

I. General information

NPI: 1093623795
Provider Name (Legal Business Name): LISA ANN RANCER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 WILDFLOWER RIDGE WAY
SUMMERFIELD NC
27358-9347
US

IV. Provider business mailing address

6300 WILDFLOWER RIDGE WAY
SUMMERFIELD NC
27358-9347
US

V. Phone/Fax

Practice location:
  • Phone: 336-486-4410
  • Fax:
Mailing address:
  • Phone: 336-486-4410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number6795
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: