MEDICARE: LISA BRANIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	0019016916	VA

General Provider Information

NPI Number	:	1003747619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA BRANIC

Provider Business Mailing Address
First Line	:	8401 MAYLAND DR STE V
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23294-4648
Country	:	US
Telephone Number	:	703-829-6734
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 N WASHINGTON ST STE 104M
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22046-3433
Country	:	US
Telephone Number	:	703-829-6734
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2026
Last Update Date	:	05/25/2026

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Directions to “ LISA BRANIC ” Practice Location

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