=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437314622
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA MARIE FISHER PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2008
-----------------------------------------------------
Last Update Date | 05/08/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4216 EVERGREEN LN STE 121
-----------------------------------------------------
City | ANNANDALE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22003-3256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-276-9337
-----------------------------------------------------
Fax | 571-234-6232
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6321 OAK RIDGE DR
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22312-1237
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-276-9337
-----------------------------------------------------
Fax | 571-234-6232
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 2305202007
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------