Healthcare Provider Details

I. General information

NPI: 1649235508
Provider Name (Legal Business Name): LISA H KERRIGAN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 03/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7560 GARDNER DRIVE
GAINESVILLE VA
20155
US

IV. Provider business mailing address

7560 GARDNER PARK DR
GAINESVILLE VA
20155-3414
US

V. Phone/Fax

Practice location:
  • Phone: 703-887-3483
  • Fax: 703-648-3830
Mailing address:
  • Phone: 703-753-1005
  • Fax: 703-753-2207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305005073
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: