Provider Demographics
NPI:1700839669
Name:COUSINS, LIDIA DEMORIZI (PT)
Entity Type:Individual
Prefix:
First Name:LIDIA
Middle Name:DEMORIZI
Last Name:COUSINS
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 1:1115 BOULDERS PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4067
Mailing Address - Country:US
Mailing Address - Phone:804-560-5595
Mailing Address - Fax:804-560-9029
Practice Address - Street 1:13700 ST FRANCIS BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-3222
Practice Address - Country:US
Practice Address - Phone:804-379-9086
Practice Address - Fax:804-379-1283
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305004726225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA540885859OtherFIRST HEALTH/CCN
VA540885859OtherFARA
VA98999OtherOPTIMA HEALTH
VA192302OtherANTHEM THERAPY
VA540885859OtherVA HEALTH NETWORK
VACIGNAOther540885859
VA1108934OtherAETNA/US (HMO)
VA540885859OtherC&O EMPLOYEES HOSP. ASSOC
VA7292707OtherAETNA
VA540885859OtherCORVEL
VA010206430Medicaid
VA540885859OtherCENVANET
VA540885859OtherCOMPMANAGEMENT
VA540885859OtherPHCS
VA540885859OtherMULTIPLAN
VA540885859OtherUNITED HEALTHCARE
VA258462OtherSOUTHERN HEALTH
VA540885859OtherFOCUS
VA540885859OtherPHCS
VA010002W25Medicare PIN