Individual
MRS. LISA TAM PETRUZZI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC, VATL
Contact information
Practice address
700 BENNETT ST, HERNDON, VA 20170-3104
(703) 810-2327
Mailing address
700 BENNETT ST, HERNDON, VA 20170-3104
(703) 810-2327
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0126000069
VA
Other
Enumeration date
06/23/2016
Last updated
06/23/2016
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