Healthcare Provider Details

I. General information

NPI: 1063928059
Provider Name (Legal Business Name): MATTHEW EARL FLYNN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2017
Last Update Date: 12/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9710 WALTHORNE CT
BURKE VA
22015-4044
US

IV. Provider business mailing address

9710 WALTHORNE CT
BURKE VA
22015-4044
US

V. Phone/Fax

Practice location:
  • Phone: 207-420-6553
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305211612
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: