Provider Demographics
NPI:1821859794
Name:LISENBY, MARION ANN (MPT)
Entity type:Individual
Prefix:
First Name:MARION
Middle Name:ANN
Last Name:LISENBY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1615
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-9615
Mailing Address - Country:US
Mailing Address - Phone:757-404-0440
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1615
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-9615
Practice Address - Country:US
Practice Address - Phone:757-404-0440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-18
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3150225100000X
VA2305004732225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist