Provider Demographics
NPI:1700988920
Name:LESTZ, ELISE GELFAND (PT)
Entity Type:Individual
Prefix:MRS
First Name:ELISE
Middle Name:GELFAND
Last Name:LESTZ
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 1:9104 SCOTT STREET
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22153
Mailing Address - Country:US
Mailing Address - Phone:703-866-4822
Mailing Address - Fax:
Practice Address - Street 1:14412 JEFFERSON DAVIS HWY
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-2806
Practice Address - Country:US
Practice Address - Phone:703-499-9399
Practice Address - Fax:703-499-9553
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305002352225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist