Provider Demographics
NPI:1700902715
Name:SISON-WRIGHT, MARIA LOURDES (PT)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:LOURDES
Last Name:SISON-WRIGHT
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 1:2108 GALLOWS RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3980
Mailing Address - Country:US
Mailing Address - Phone:703-930-1338
Mailing Address - Fax:703-763-2333
Practice Address - Street 1:2108 GALLOWS RD
Practice Address - Street 2:SUITE A
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3980
Practice Address - Country:US
Practice Address - Phone:703-930-1338
Practice Address - Fax:703-763-2333
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305004830225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA76820001OtherBLUECROSS BLUE SHIELD