Provider Demographics
NPI:1821183203
Name:CULVER, LISA L (PT, MBA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:L
Last Name:CULVER
Suffix:
Gender:F
Credentials:PT, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 CLARENDON BLVD, #716
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-5845
Mailing Address - Country:US
Mailing Address - Phone:703-527-8165
Mailing Address - Fax:
Practice Address - Street 1:1111 NORTH FAIRFAX STREET
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-1488
Practice Address - Country:US
Practice Address - Phone:703-706-3172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305002798225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist