Provider Demographics
NPI:1881306330
Name:LACY, NATOYA (PT, DPT)
Entity type:Individual
Prefix:
First Name:NATOYA
Middle Name:
Last Name:LACY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 TRAILSIDE PL APT 1201
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28104-8768
Mailing Address - Country:US
Mailing Address - Phone:910-528-1431
Mailing Address - Fax:
Practice Address - Street 1:13620 REESE BLVD E STE 130
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-6418
Practice Address - Country:US
Practice Address - Phone:704-274-5795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-15
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP24526225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist