Provider Demographics
NPI:1366631251
Name:BARONE, GREG ALAN (MPT/CWS)
Entity type:Individual
Prefix:MR
First Name:GREG
Middle Name:ALAN
Last Name:BARONE
Suffix:
Gender:F
Credentials:MPT/CWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 CORPORATE LN
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-9274
Mailing Address - Country:US
Mailing Address - Phone:757-923-3207
Mailing Address - Fax:757-923-3208
Practice Address - Street 1:3005 CORPORATE LN
Practice Address - Street 2:SUITE 200
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-9274
Practice Address - Country:US
Practice Address - Phone:757-923-3207
Practice Address - Fax:757-923-3208
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305202479225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA195317OtherANTHEM
VAOOV230T23Medicare PIN