Provider Demographics
NPI:1962431486
Name:MOTTER, LISA JILL (PT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:JILL
Last Name:MOTTER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4819 WILLIAMSBURG GLADE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-2115
Mailing Address - Country:US
Mailing Address - Phone:757-565-1669
Mailing Address - Fax:
Practice Address - Street 1:4819 WILLIAMSBURG GLADE
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-2115
Practice Address - Country:US
Practice Address - Phone:757-565-1669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305003270225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist