Provider Demographics
NPI:1922884998
Name:FOUTZ, MACY ALEXANDRA
Entity Type:Individual
Prefix:
First Name:MACY
Middle Name:ALEXANDRA
Last Name:FOUTZ
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 1:6211 BACHELOR RD NW
Mailing Address - Street 2:
Mailing Address - City:WAYNESBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44688-9406
Mailing Address - Country:US
Mailing Address - Phone:330-205-5097
Mailing Address - Fax:
Practice Address - Street 1:3200 SHAKERAG HL STE C
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-6524
Practice Address - Country:US
Practice Address - Phone:707-487-0760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT020713225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist