Provider Demographics
NPI:1437314622
Name:FISHER, LISA MARIE (PT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:FISHER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6321 OAK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-1237
Mailing Address - Country:US
Mailing Address - Phone:571-276-9337
Mailing Address - Fax:571-234-6232
Practice Address - Street 1:4216 EVERGREEN LN STE 121
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3256
Practice Address - Country:US
Practice Address - Phone:571-276-9337
Practice Address - Fax:571-234-6232
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
VA2305202007225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist