Healthcare Provider Details

I. General information

NPI: 1710235486
Provider Name (Legal Business Name): LISA M SIANO PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 08/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

267 GARRISONVILLE RD SUITE 101
STAFFORD VA
22554-1596
US

IV. Provider business mailing address

8316 ARLINGTON BLVD SUITE 400
FAIRFAX VA
22031-5207
US

V. Phone/Fax

Practice location:
  • Phone: 540-288-9761
  • Fax: 540-288-9764
Mailing address:
  • Phone: 703-560-3190
  • Fax: 703-560-3194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305207584
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: