Provider Demographics
NPI:1316315161
Name:STULL, LEAH A (PT, DPT)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:A
Last Name:STULL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:A
Other - Last Name:SAMUELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:45544 MALLARD POINT TER
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-6575
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:46531 HARRY BYRD HWY
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20164-3555
Practice Address - Country:US
Practice Address - Phone:703-834-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-10
Last Update Date:2022-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1266639225100000X
NM4720225100000X
VA2305209767225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist