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General NPI Number Information
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NPI Number | 1306581129
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Entity Type | Individual
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Provider Name | LISA A GRADY LPTA, LMT
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Gender | Female
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Dates
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Enumeration Date | 05/05/2022
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Last Update Date | 05/05/2022
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Provider Practice Location Address
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Address Line | 900 STANHOPE GDNS STE 101
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City | CHESAPEAKE
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State | VA
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Zip | 23320-0709
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Country | US
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Telephone | 757-842-6562
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Fax | 757-842-6563
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Provider Business Mailing Address
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Address Line | 900 STANHOPE GDNS STE 101
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City | CHESAPEAKE
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State | VA
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Zip | 23320-0709
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Country | US
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Telephone | 757-842-6562
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Fax | 757-842-6563
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 0019012791
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2306604026
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License Number State | VA
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