MEDICARE: LACEY AUTUMN HARRIS PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	4887	SC

General Provider Information

NPI Number	:	1770215063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LACEY AUTUMN HARRIS PTA

Provider Business Mailing Address
First Line	:	4871 SOCASTEE BLVD UNIT E
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-7252
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4871 SOCASTEE BLVD UNIT E
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-7252
Country	:	US
Telephone Number	:	843-293-5610
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2022
Last Update Date	:	06/27/2022

Similar Medicare Providers

1386076818 — AMANDA LYN MILANAK PT, DPT
Practice Location Address:

4871 SOCASTEE BLVD UNIT E
MYRTLE BEACH, SC
29588-7252

Practice Phone: 843-293-5610
Practice Fax:

1932178498 — MRS. CATHERINE MARIE SHELTON MAPT
Practice Location Address:

4871 SOCASTEE BLVD , SUITE E
MYRTLE BEACH, SC
29588-7252

Practice Phone: 843-293-5610
Practice Fax: 843-293-5690

1609940394 — LONG BAY REHAB, LLC
Practice Location Address:

4871 SOCASTEE BLVD UNIT E
MYRTLE BEACH, SC
29588-7252

Practice Phone: 843-293-5610
Practice Fax: 843-293-5690

1609231281 — CHRISTINE ELAINE CROWE PT, AT
Practice Location Address:

4871 SOCASTEE BLVD
MYRTLE BEACH, SC
29588-7252

Practice Phone: 843-293-5610
Practice Fax: 843-293-5690

1295259463 — ERIK MICHAEL KARPINSKI PT, DPT
Practice Location Address:

4871 SOCASTEE BLVD UNIT E
MYRTLE BEACH, SC
29588-7252

Practice Phone: 843-293-5610
Practice Fax:

1386278216 — NICHOLAS FRANCIS MERCALDO
Practice Location Address:

4871 SOCASTEE BLVD UNIT E
MYRTLE BEACH, SC
29588-7252

Practice Phone: 843-293-5610
Practice Fax:

Directions to “ LACEY AUTUMN HARRIS PTA” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.