Provider Demographics
NPI:1306581129
Name:GRADY, LISA A (LPTA, LMT)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:A
Last Name:GRADY
Suffix:
Gender:F
Credentials:LPTA, LMT
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:A
Other - Last Name:FARNEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPTA, LMT
Mailing Address - Street 1:900 STANHOPE GDNS STE 101
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-0709
Mailing Address - Country:US
Mailing Address - Phone:757-842-6562
Mailing Address - Fax:757-842-6563
Practice Address - Street 1:900 STANHOPE GDNS STE 101
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-0709
Practice Address - Country:US
Practice Address - Phone:757-842-6562
Practice Address - Fax:757-842-6563
Is Sole Proprietor?:No
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0019012791225700000X
VA2306604026225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist