Healthcare Provider Details

I. General information

NPI: 1508473778
Provider Name (Legal Business Name): LISA HOANG MOSER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2020
Last Update Date: 10/09/2020
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12436 DILLINGHAM SQ
LAKE RIDGE VA
22192-5258
US

IV. Provider business mailing address

3933 PENSHURST LN APT 101
WOODBRIDGE VA
22192-6360
US

V. Phone/Fax

Practice location:
  • Phone: 703-340-2921
  • Fax:
Mailing address:
  • Phone: 908-202-1345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: