Provider Demographics
NPI:1598983298
Name:ARBO, LISA PHILLIPS (PTA)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:PHILLIPS
Last Name:ARBO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 993
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:22066-0993
Mailing Address - Country:US
Mailing Address - Phone:703-444-5005
Mailing Address - Fax:703-444-7250
Practice Address - Street 1:21400 RIDGETOP CIRCLE
Practice Address - Street 2:SUITE 130
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166
Practice Address - Country:US
Practice Address - Phone:703-444-5005
Practice Address - Fax:703-444-7250
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306000094225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant