MEDICARE: MATTHEW D BABBITT 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	PT010119L	PA
2	2251S0007X	Sports Physical Therapist	PT010119L	PA
3	2251X0800X	Orthopedic Physical Therapist	PT010119L	PA
4	225100000X	Physical Therapist	2305214847	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	02168901	OTHER	PA	BLUE CROSS
2	869617	OTHER	PA	BLUE SHIELD
3	896917	OTHER	PA	PERSONAL CHOICE
4	02168901	OTHER		KEYSTONE CENTRAL
5	0052130	OTHER	PA	ORTHONET
6	869617	OTHER	PA	FIRST PRIORITY LIFE
7	7703097	OTHER	PA	AETNA

General Provider Information

NPI Number	:	1073508677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW D BABBITT DPT

Provider Business Mailing Address
First Line	:	PO BOX 37174
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21297-3174
Country	:	US
Telephone Number	:	571-423-5699
Fax Number	:	571-423-5698

Provider Business Practice Location Address
First Line	:	24801 PINEBROOK RD STE 200
Second Line	:
City	:	CHANTILLY
State	:	VA
Zip	:	20152-4113
Country	:	US
Telephone Number	:	703-722-2525
Fax Number	:	703-327-6708

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

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	02/11/2022

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