Healthcare Provider Details

I. General information

NPI: 1750790283
Provider Name (Legal Business Name): LISA CLARKSON DPT, OCS, FMCP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2014
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12642 CHAPEL RD
CLIFTON VA
20124-1953
US

IV. Provider business mailing address

12642 CHAPEL RD
CLIFTON VA
20124-1953
US

V. Phone/Fax

Practice location:
  • Phone: 703-349-5170
  • Fax: 866-316-7108
Mailing address:
  • Phone: 703-349-5170
  • Fax: 866-316-7108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT872383
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305208849
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: