Provider Demographics
NPI:1699781245
Name:PETRONE, MATTHEW ROBERT (PT, DPT)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:ROBERT
Last Name:PETRONE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:115 BUCKINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-1206
Mailing Address - Country:US
Mailing Address - Phone:804-734-5443
Mailing Address - Fax:804-734-9562
Practice Address - Street 1:700 24TH ST
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:VA
Practice Address - Zip Code:23801-1716
Practice Address - Country:US
Practice Address - Phone:804-734-9200
Practice Address - Fax:804-734-9562
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052048602251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic