Healthcare Provider Details

I. General information

NPI: 1386627339
Provider Name (Legal Business Name): ROBERT J MAROON PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W BRAMBLETON AVE STE 202
NORFOLK VA
23510-1115
US

IV. Provider business mailing address

1450 KEMPSVILLE RD STE 102
VIRGINIA BEACH VA
23464-7320
US

V. Phone/Fax

Practice location:
  • Phone: 757-623-0867
  • Fax: 757-627-2923
Mailing address:
  • Phone: 757-962-1618
  • Fax: 757-481-6175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305003099
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: