Provider Demographics
NPI:1437349651
Name:ELSWICK, LISA B (PT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:B
Last Name:ELSWICK
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:PO BOX 7848
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-0848
Mailing Address - Country:US
Mailing Address - Phone:757-398-0853
Mailing Address - Fax:757-398-0030
Practice Address - Street 1:3300 HIGH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-3321
Practice Address - Country:US
Practice Address - Phone:757-673-5689
Practice Address - Fax:757-673-5678
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203457225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA014788O04Medicare PIN