Provider Demographics
NPI:1457602344
Name:ROLL, LORI JEAN (PT)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:JEAN
Last Name:ROLL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:JEAN
Other - Last Name:GIESELMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:46304 MCCLELLAN WAY
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-7243
Mailing Address - Country:US
Mailing Address - Phone:703-444-8210
Mailing Address - Fax:703-444-8213
Practice Address - Street 1:46304 MCCLELLAN WAY
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-7243
Practice Address - Country:US
Practice Address - Phone:703-444-8210
Practice Address - Fax:703-444-8213
Is Sole Proprietor?:No
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305004687225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist