Healthcare Provider Details

I. General information

NPI: 1396606612
Provider Name (Legal Business Name): MARION LISENBY MSPT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2025
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 SHIP SHOAL WAY
VIRGINIA BEACH VA
23451-6544
US

IV. Provider business mailing address

139 SHIP SHOAL WAY
VIRGINIA BEACH VA
23451-6544
US

V. Phone/Fax

Practice location:
  • Phone: 757-404-0440
  • Fax: 757-524-4004
Mailing address:
  • Phone: 757-404-0440
  • Fax: 757-524-4004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARION A LISENBY
Title or Position: OWNER/OPERATOR
Credential: MSPT
Phone: 757-404-0440