Provider Demographics
NPI:1164520482
Name:KLEIN, LISA R (PT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:R
Last Name:KLEIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 E NELSON AVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22301-2035
Mailing Address - Country:US
Mailing Address - Phone:301-785-0363
Mailing Address - Fax:
Practice Address - Street 1:900 19TH ST NW
Practice Address - Street 2:#250
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-2105
Practice Address - Country:US
Practice Address - Phone:202-466-8881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC870112225100000X
VA2305203115225100000X
CAPT32836225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG01820C01Medicare ID - Type Unspecified