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 1:139 SHIP SHOAL WAY
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-6544
Practice Address - Country:US
Practice Address - Phone:757-404-0440
Practice Address - Fax:757-524-4004
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-18
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3150225100000X
VA23050047322251G0304X, 261QP2000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy