Lacey Powell

Primary specialty

Physical TherapistTaxonomy code 225100000X

Practice address

108 Debo Dr Ste 130
Myrtle Beach, SC 29579-4918

Phone

(843) 796-2850

NPI assigned

Jun 14, 2023

Last updated

Jun 14, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Back in Form Physical Therapy Inc.Group PAC ID 5496929820, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Back in Form Physical Therapy Inc.

  • Physical Therapist
  • Vero Beach, FL
  • NPI 1518247873
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1686700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686700800000",
    "number": "1114601473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 CORPORATE DR STE 400",
            "city": "HOOVER",
            "state": "AL",
            "postal_code": "352425424",
            "telephone_number": "423-682-8840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 DEBO DR STE 130",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295794918",
            "telephone_number": "843-796-2850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POWELL",
        "first_name": "LACEY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-14",
        "last_updated": "2023-06-14",
        "certification_date": "2023-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Lee Poulos Jr., PHARMD.
• Dana Bettina Pournaras, M.D
• Vasilios Pournaras, DMD
• Azhane Powell, LISW
• Jessica Lynne Powell
• Power Cutz Barber Shop LLC
• Lauren Marie Pratt, MD
• Terry Lynn Pratt, FNP-C
• Premise Health of South Carolina Medical PC (City of Myrtle Beach - Mr Joe White Ave)
• Premise Health of South Carolina Medical, P.C (City of Myrtle Beach - N Kings Hwy)

• Physical Therapist in Myrtle Beach, SC
• Providers in Myrtle Beach, SC by specialty
• Physical Therapist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.