Basic Information
Provider Information | |||||||||
NPI: | 1043546617 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LANCASTER | ||||||||
FirstName: | LAURIE | ||||||||
MiddleName: | STINER | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | PT | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 1769 | ||||||||
Address2: |   | ||||||||
City: | MIDDLEBURG | ||||||||
State: | VA | ||||||||
PostalCode: | 201181769 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5406878181 | ||||||||
FaxNumber: | 5406878256 | ||||||||
Practice Location | |||||||||
Address1: | 119 THE PLAINS RD STE 100 | ||||||||
Address2: |   | ||||||||
City: | MIDDLEBURG | ||||||||
State: | VA | ||||||||
PostalCode: | 201172691 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5406878181 | ||||||||
FaxNumber: | 5406878256 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/02/2009 | ||||||||
LastUpdateDate: | 10/07/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 10/07/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT60021231 | WA | N |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   | 225100000X | 2305207299 | VA | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
ID Information
ID | Type | State | Issuer | Description | 0256195 | 01 | WA | L&I | OTHER | 0258814 | 01 | WA | L&I | OTHER | 0103LA | 01 | WA | REGENCE | OTHER | 0108LA | 01 | WA | REGENCE | OTHER | 0109LA | 01 | WA | REGENCE | OTHER | 0258857 | 01 | WA | L&I | OTHER | 0160LA | 01 | WA | REGENCE | OTHER | 1043546619 | 01 | WA | DSHS | OTHER | 0104LA | 01 | WA | REGENCE | OTHER | 0102LA | 01 | WA | REGENCE | OTHER | 0106LA | 01 | WA | REGENCE | OTHER | 0159LA | 01 | WA | REGENCE | OTHER | 0101LA | 01 | WA | REGENCE | OTHER | 0107LA | 01 | WA | REGENCE | OTHER |