MEDICARE: JOHN ROONEY PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1043839475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN ROONEY PT, DPT

Provider Business Mailing Address
First Line	:	4406 LEONARD PKWY
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23221-1808
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9101 BON AIR CROSSINGS DR
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-4968
Country	:	US
Telephone Number	:	804-521-9980
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/15/2020
Last Update Date	:	04/15/2020

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