Provider Demographics
NPI:1396975215
Name:LASSITER, LYNN RUSHING (PT, DPT, CIMT)
Entity type:Individual
Prefix:DR
First Name:LYNN
Middle Name:RUSHING
Last Name:LASSITER
Suffix:
Gender:F
Credentials:PT, DPT, CIMT
Other - Prefix:DR
Other - First Name:LYNN
Other - Middle Name:MARCELLA
Other - Last Name:RUSHING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:350 W 22ND ST STE 108
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23517-2107
Mailing Address - Country:US
Mailing Address - Phone:757-216-4151
Mailing Address - Fax:
Practice Address - Street 1:350 W 22ND ST STE 108
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-2107
Practice Address - Country:US
Practice Address - Phone:757-216-4151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-27
Last Update Date:2020-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206084225100000X
2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9838376OtherAETNA
VA1396975215Medicaid
VA192931OtherBCBS (PHYSICAL THERAPY)
VAP00733187OtherMEDICARE RAILROAD
VA192931OtherBCBS (PHYSICAL THERAPY)
VAP00733187OtherMEDICARE RAILROAD