MEDICARE: DR. ELIZABETH LEIN POLIS PT, DPT

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	2251X0800X	Orthopedic Physical Therapist	2305205043	VA

General Provider Information

NPI Number	:	1134195175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH LEIN POLIS PT, DPT

Provider Business Mailing Address
First Line	:	2212 MOUNT VERNON AVE
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22301-1356
Country	:	US
Telephone Number	:	571-309-3048
Fax Number	:	571-366-2052

Provider Business Practice Location Address
First Line	:	2212 MOUNT VERNON AVE
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22301-1356
Country	:	US
Telephone Number	:	571-309-3048
Fax Number	:	571-366-2052

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

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	05/22/2012

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