Healthcare Provider Details

I. General information

NPI: 1891160735
Provider Name (Legal Business Name): HUNTER DANIEL MATHIAS DPT, PT, ATC, AEMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2015
Last Update Date: 08/10/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13039 WORLDGATE DR
HERNDON VA
20170-4374
US

IV. Provider business mailing address

PO BOX 1769
MIDDLEBURG VA
20118-1769
US

V. Phone/Fax

Practice location:
  • Phone: 703-689-3164
  • Fax: 703-689-3167
Mailing address:
  • Phone: 703-689-3164
  • Fax: 703-689-3167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305213021
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: