Provider Demographics
NPI:1083332191
Name:LINCOLN, ELISABETH (PT)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:
Last Name:LINCOLN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4837
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-4837
Mailing Address - Country:US
Mailing Address - Phone:704-799-2873
Mailing Address - Fax:
Practice Address - Street 1:125 COMMERCE PARK RD STE 105
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-4818
Practice Address - Country:US
Practice Address - Phone:704-799-2873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP19487225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist