Lisa Gordon Latourette, MSPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2305203147 Issued in VA

Practice address

8575 Rixlew LN
Manassas, VA 20109-3701

Phone

(703) 257-3364

NPI assigned

May 11, 2006

Last updated

Dec 30, 2011By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Lisa Dyann Gordon Former name

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2000

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Powerback Rehabilitation LLC

  dba Powerback Rehabilitation

  • Physical Therapist
  • Virginia Beach, VA
  • NPI 1871241414
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1325203200000",
    "number": "1356391536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8575 RIXLEW LN",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201093701",
            "telephone_number": "703-257-3364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8575 RIXLEW LN",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201093701",
            "telephone_number": "703-257-3364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LATOURETTE",
        "first_name": "LISA",
        "middle_name": "GORDON",
        "credential": "MSPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-11",
        "last_updated": "2011-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305203147",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "GORDON",
            "middle_name": "DYANN",
            "credential": "MSPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kathryn Quinnette Laslie, OTR/L
• Nadia Lassic, PMHNP-BC
• Lasting Serenity Telepsychiatry Inc
• Sameeha Afshan Latif, BCABA
• Robert A W Latimer, M.D.
• Lauren Fisher, PSYD, PLLC
• Taylor Marie Laurita, DPT
• Caroline Damon Lauver
• Elizabeth Munter Lavery, M.D.
• Rekha Lawande, MD

• Physical Therapist in Manassas, VA
• Providers in Manassas, VA by specialty
• Physical Therapist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.