Provider Demographics
NPI:1770740706
Name:LAWHORNE, STACEY ANN (PT)
Entity type:Individual
Prefix:MS
First Name:STACEY
Middle Name:ANN
Last Name:LAWHORNE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:14460 NEW FALLS OF THE NEUSE ROAD
Mailing Address - Street 2:SUITE 149-203
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614
Mailing Address - Country:US
Mailing Address - Phone:919-382-0150
Mailing Address - Fax:888-746-5470
Practice Address - Street 1:107 INDUSTRIAL DRIVE
Practice Address - Street 2:SUITE C
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549
Practice Address - Country:US
Practice Address - Phone:919-496-2143
Practice Address - Fax:919-496-8141
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC2263225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist