Provider Demographics
NPI:1801098652
Name:GAY, LISA (PT)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:GAY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:HAGEMEISTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:15139 WETHERBURN DR
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-3925
Mailing Address - Country:US
Mailing Address - Phone:703-830-3717
Mailing Address - Fax:
Practice Address - Street 1:13350 FRANKLIN FARM RD
Practice Address - Street 2:STE. 300
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-4091
Practice Address - Country:US
Practice Address - Phone:703-234-1045
Practice Address - Fax:703-471-0280
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305003496225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist