Provider Demographics
NPI:1962895730
Name:MATTHEW, DORIS CHIDINMA (PTA)
Entity type:Individual
Prefix:MRS
First Name:DORIS
Middle Name:CHIDINMA
Last Name:MATTHEW
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MRS
Other - First Name:DORIS
Other - Middle Name:CHIDINMA
Other - Last Name:UZOECHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3482 AVIARY WAY
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-1077
Mailing Address - Country:US
Mailing Address - Phone:703-881-6655
Mailing Address - Fax:
Practice Address - Street 1:900 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-3200
Practice Address - Country:US
Practice Address - Phone:703-684-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-18
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306603921225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant