Provider Demographics
NPI:1144745217
Name:GRIMMER, LISA NICOLE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:NICOLE
Last Name:GRIMMER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1565 N COLONIAL TER APT 403
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22209-1425
Mailing Address - Country:US
Mailing Address - Phone:202-246-0428
Mailing Address - Fax:
Practice Address - Street 1:2233 WISCONSIN AVE NW STE 217
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-4140
Practice Address - Country:US
Practice Address - Phone:202-333-5252
Practice Address - Fax:202-333-1159
Is Sole Proprietor?:No
Enumeration Date:2017-08-09
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT872119225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCPT872119OtherPT LICENSE NUMBER