Healthcare Provider Details

I. General information

NPI: 1942135512
Provider Name (Legal Business Name): LACY JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1622 TIMBERWOOD BLVD STE 211
CHARLOTTESVILLE VA
22911-7545
US

IV. Provider business mailing address

305 DASHING WAVE LN
ALPHARETTA GA
30005-4232
US

V. Phone/Fax

Practice location:
  • Phone: 434-202-2830
  • Fax: 434-529-8457
Mailing address:
  • Phone: 404-310-3375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT018289
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP058728T
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: