Healthcare Provider Details

I. General information

NPI: 1114303294
Provider Name (Legal Business Name): LISA OSTERHOUDT LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2015
Last Update Date: 07/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4667 SIR GILBERT LOOP
WILLIAMSBURG VA
23185-7947
US

IV. Provider business mailing address

4667 SIR GILBERT LOOP
WILLIAMSBURG VA
23185-7947
US

V. Phone/Fax

Practice location:
  • Phone: 530-693-5570
  • Fax:
Mailing address:
  • Phone: 530-693-5570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306604234
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: