Provider Demographics
NPI:1225396955
Name:NELSON, LYNN (PT)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:NELSON
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 1:13505 HEATHROW LN
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-6404
Mailing Address - Country:US
Mailing Address - Phone:703-266-2377
Mailing Address - Fax:
Practice Address - Street 1:8100 ASHTON AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-5622
Practice Address - Country:US
Practice Address - Phone:571-379-5285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-01
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305003355225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist