Provider Demographics
NPI:1962150565
Name:TALLEY, MATTHEW A (ATC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:A
Last Name:TALLEY
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2607 COLONIAL AVE APT 119
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23517-1338
Mailing Address - Country:US
Mailing Address - Phone:603-285-5186
Mailing Address - Fax:
Practice Address - Street 1:7336 GRANBY ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-3492
Practice Address - Country:US
Practice Address - Phone:603-285-5186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-13
Last Update Date:2022-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer