Provider Demographics
NPI:1669768891
Name:VINCENT, LISA A (MPT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:VINCENT
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:A
Other - Last Name:SZLACHTIANSHYN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:901 ENTERPRISE PKWY
Mailing Address - Street 2:SUITE 900
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-6249
Mailing Address - Country:US
Mailing Address - Phone:757-827-2422
Mailing Address - Fax:
Practice Address - Street 1:901 ENTERPRISE PKWY
Practice Address - Street 2:SUITE 900
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-6249
Practice Address - Country:US
Practice Address - Phone:757-827-2422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305006736225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist