Healthcare Provider Details

I. General information

NPI: 1083805477
Provider Name (Legal Business Name): LYNN KULLA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6225 BRANDON AVE STE 130
SPRINGFIELD VA
22150-2519
US

IV. Provider business mailing address

1289 OLIVER ST
FAYETTEVILLE NC
28304-4450
US

V. Phone/Fax

Practice location:
  • Phone: 703-569-7500
  • Fax:
Mailing address:
  • Phone: 910-483-8331
  • Fax: 910-483-8335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305211149
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: