Provider Demographics
NPI:1730854068
Name:MATHESON, MATTY (DPT)
Entity type:Individual
Prefix:
First Name:MATTY
Middle Name:
Last Name:MATHESON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 AGUILA DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-8034
Mailing Address - Country:US
Mailing Address - Phone:757-572-9314
Mailing Address - Fax:
Practice Address - Street 1:2247 W GREAT NECK RD STE 101
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-1556
Practice Address - Country:US
Practice Address - Phone:757-742-3778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT422932251X0800X
VA23052145432251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic