Provider Demographics
NPI:1245036243
Name:MACASPAC, KC ANN LEJARDE
Entity type:Individual
Prefix:
First Name:KC ANN
Middle Name:LEJARDE
Last Name:MACASPAC
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 ELBERTON AVE
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-4427
Mailing Address - Country:US
Mailing Address - Phone:843-568-1616
Mailing Address - Fax:
Practice Address - Street 1:116 SPRINGHALL DR STE A
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-5372
Practice Address - Country:US
Practice Address - Phone:843-330-4496
Practice Address - Fax:843-212-4951
Is Sole Proprietor?:No
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC46332251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic