Healthcare Provider Details

I. General information

NPI: 1053367326
Provider Name (Legal Business Name): MATTHEW PETER WREN M.S., P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2296 JOHN ROLFE PKWY
RICHMOND VA
23233-3548
US

IV. Provider business mailing address

2296 JOHN ROLFE PKWY
RICHMOND VA
23233-3548
US

V. Phone/Fax

Practice location:
  • Phone: 804-741-7077
  • Fax: 804-741-0377
Mailing address:
  • Phone: 804-741-7077
  • Fax: 804-741-0377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305003703
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: