Healthcare Provider Details

I. General information

NPI: 1104869411
Provider Name (Legal Business Name): LISA J ALLEN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19441 GOLF VISTA PLAZA STE 340
LEESBURG VA
20176
US

IV. Provider business mailing address

36995 GAVER MILL RD
HILLSBORO VA
20132-2758
US

V. Phone/Fax

Practice location:
  • Phone: 703-723-7726
  • Fax: 703-723-9587
Mailing address:
  • Phone: 540-668-6579
  • Fax: 540-668-6562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberVA2305204090
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: