Provider Demographics
NPI:1427121409
Name:MACKAY, LORRAIN (PT)
Entity type:Individual
Prefix:MS
First Name:LORRAIN
Middle Name:
Last Name:MACKAY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19224 GREEN HERON DR.
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-3972
Mailing Address - Country:US
Mailing Address - Phone:225-636-2822
Mailing Address - Fax:
Practice Address - Street 1:19224 GREEN HERON DR.
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-3972
Practice Address - Country:US
Practice Address - Phone:225-636-2822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA02040F225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4B532Medicare UPIN