Basic Information
| Provider Information | |||||||||
| NPI: | 1649734500 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NELSON | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | RPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 705 WINTERGREEN DR | ||||||||
| Address2: | |||||||||
| City: | PURCELLVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201323290 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403382973 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6066 LEESBURG PIKE STE 900 | ||||||||
| Address2: | |||||||||
| City: | FALLS CHURCH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220412240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038202001 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2019 | ||||||||
| LastUpdateDate: | 01/24/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2305003392 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.