Legacy Physiatry Group North Carolina

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

LEGACY PHYSIATRY GROUP NORTH CAROLINA

Doing business as

Legacy Physiatry Group NC

Practice address

3520 Airport Blvd NW Ste D
Wilson, NC 27896-8674

Phone

(855) 655-7777

NPI assigned

Aug 25, 2021

Organization subpart

No

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

Authorized official

Name

Venkatesh Lakshman, MD

Title

Ceo/President

Phone

(972) 881-4688

Specialties & licenses 1

Addresses

Other names 1

• Legacy Physiatry Group NC Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kennitrish Nickola Bracey, DNP, APRN, AGNP-C

  • Primary Care Nurse Practitioner
  • Greensboro, NC
  • NPI 1295334647
  NPD (past)

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

{
    "created_epoch": "1629849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641340800000",
    "number": "1841967064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 CENTRAL PKWY E STE 275",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750745542",
            "telephone_number": "972-881-4688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3520 AIRPORT BLVD NW STE D",
            "city": "WILSON",
            "state": "NC",
            "postal_code": "278968674",
            "telephone_number": "855-655-7777"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3520 Airport Blvd NW Ste D",
            "address_purpose": "LOCATION",
            "city": "Wilson",
            "state": "NC",
            "postal_code": "278968674",
            "country_code": "US",
            "telephone_number": "855-655-7777",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LEGACY PHYSIATRY GROUP NORTH CAROLINA",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-25",
        "last_updated": "2022-01-05",
        "certification_date": "2022-01-05",
        "status": "A",
        "authorized_official_last_name": "LAKSHMAN",
        "authorized_official_first_name": "VENKATESH",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "972-881-4688",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Legacy Physiatry Group NC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Cyrus Andrew Lee, D.D.S.
• Cyrus F. Lee Jr., D.D.S.
• Jessica Lee, M.S., CCC-SLP
• Rachel Lara Lee, MSN, RN, CPNP-PC
• Legacy Healthcare Services, Inc
• Keith Lerro, M.D.
• Ginna Ashley Lewis, MS, LAT, ATC, CSCS
• Scott Marshall Lewis, MD
• Dianna Life
• Life, Inc.

• Physical Medicine & Rehabilitation Physician in Wilson, NC
• Providers in Wilson, NC by specialty
• Physical Medicine & Rehabilitation Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.