Provider Demographics
NPI:1275185217
Name:WILLIAMS, LISA STONER
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:STONER
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 MCLAWS CIR STE 203
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-5654
Mailing Address - Country:US
Mailing Address - Phone:757-565-5400
Mailing Address - Fax:
Practice Address - Street 1:428 MCLAWS CIR STE 203
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-5654
Practice Address - Country:US
Practice Address - Phone:757-565-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT2305204486225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist