Healthcare Provider Details

I. General information

NPI: 1407763972
Provider Name (Legal Business Name): UPLIFT MEDICAL SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4310 RIDGEWOOD CENTER DR
WOODBRIDGE VA
22192-5307
US

IV. Provider business mailing address

4310 RIDGEWOOD CENTER DR
WOODBRIDGE VA
22192-5307
US

V. Phone/Fax

Practice location:
  • Phone: 703-716-3890
  • Fax:
Mailing address:
  • Phone: 703-716-3890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. THERESA DAVIS LYON
Title or Position: OWNER
Credential:
Phone: 703-716-3890