Provider Demographics
NPI:1639376429
Name:MACKEY, LELIA JOHNSON (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:LELIA
Middle Name:JOHNSON
Last Name:MACKEY
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 HOWARD HTS
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-3038
Mailing Address - Country:US
Mailing Address - Phone:770-387-9873
Mailing Address - Fax:
Practice Address - Street 1:958 JOE FRANK HARRIS PKWY SE STE 103
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-2158
Practice Address - Country:US
Practice Address - Phone:770-387-8188
Practice Address - Fax:770-606-2110
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002669225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist