Provider Demographics
NPI:1093060311
Name:SHIOMICHI, MATTHEW M (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:M
Last Name:SHIOMICHI
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 36007
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-8000
Mailing Address - Country:US
Mailing Address - Phone:804-484-3700
Mailing Address - Fax:804-320-6462
Practice Address - Street 1:161 WADSWORTH DR
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23236-4500
Practice Address - Country:US
Practice Address - Phone:804-484-3700
Practice Address - Fax:804-320-6462
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24103225100000X, 2251X0800X
VA2305213888225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic