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General NPI Number Information
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NPI Number | 1245209188
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Entity Type | Individual
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Provider Name | MATTHEW PULISIC DPT MS OCS
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Gender | Male
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 10/16/2019
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Provider Practice Location Address
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Address Line | 203 N WASHINGTON HWY
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City | ASHLAND
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State | VA
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Zip | 23005
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Country | US
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Telephone | 804-340-1193
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Fax | 804-340-1930
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Provider Business Mailing Address
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Address Line | 203 N WASHINGTON HWY
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City | ASHLAND
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State | VA
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Zip | 23005-1623
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Country | US
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Telephone | 804-798-1112
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Fax | 804-798-1171
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305003929
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License Number State | VA
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