Provider Demographics
NPI:1639888704
Name:NEUBAUER, KACEY L
Entity Type:Individual
Prefix:
First Name:KACEY
Middle Name:L
Last Name:NEUBAUER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 CAMPUS PARK DR STE D
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-5270
Mailing Address - Country:US
Mailing Address - Phone:704-283-9422
Mailing Address - Fax:704-283-9423
Practice Address - Street 1:1630 CAMPUS PARK DR STE D
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5270
Practice Address - Country:US
Practice Address - Phone:704-283-9422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-17
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH5079225100000X
NCP22745225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist