Provider Demographics
NPI:1376667113
Name:SEALY, LORI JEAN
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:JEAN
Last Name:SEALY
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 1:8077 STILLBROOKE RD
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20112-4631
Mailing Address - Country:US
Mailing Address - Phone:703-794-1529
Mailing Address - Fax:
Practice Address - Street 1:2133 MONTGOMERY AVE
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-2655
Practice Address - Country:US
Practice Address - Phone:703-490-6517
Practice Address - Fax:703-490-3525
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306000927225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant