MEDICARE: LISA MARIE FISHER PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist
2	225100000X	Physical Therapist	2305202007	VA

General Provider Information

NPI Number	:	1437314622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MARIE FISHER PT

Provider Business Mailing Address
First Line	:	6321 OAK RIDGE DR
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22312-1237
Country	:	US
Telephone Number	:	571-276-9337
Fax Number	:	571-234-6232

Provider Business Practice Location Address
First Line	:	4216 EVERGREEN LN STE 121
Second Line	:
City	:	ANNANDALE
State	:	VA
Zip	:	22003-3256
Country	:	US
Telephone Number	:	571-276-9337
Fax Number	:	571-234-6232

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2008
Last Update Date	:	05/08/2020

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Directions to “ LISA MARIE FISHER PT” Practice Location

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