Healthcare Provider Details

I. General information

NPI: 1003747619
Provider Name (Legal Business Name): LISA BRANIC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N WASHINGTON ST STE 104M
FALLS CHURCH VA
22046-3433
US

IV. Provider business mailing address

8401 MAYLAND DR STE V
HENRICO VA
23294-4648
US

V. Phone/Fax

Practice location:
  • Phone: 703-829-6734
  • Fax:
Mailing address:
  • Phone: 703-829-6734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0019016916
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: