Provider Demographics
NPI:1356303861
Name:FLANNERY, JOSEPH P (PT, DPT, OCS, CIMT)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:P
Last Name:FLANNERY
Suffix:
Gender:M
Credentials:PT, DPT, OCS, CIMT
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 69030
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-9030
Mailing Address - Country:US
Mailing Address - Phone:757-873-2302
Mailing Address - Fax:757-873-2306
Practice Address - Street 1:4125 IRONBOUND RD STE 100
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-2666
Practice Address - Country:US
Practice Address - Phone:757-220-8383
Practice Address - Fax:757-253-7833
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204164225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010210704Medicaid
VAP00356007OtherMEDICARE RAILROAD
7222622OtherAETNA
VA192935OtherBCBS PHYSICAL THERAPY
VA192935OtherBCBS PHYSICAL THERAPY
VA008154T54Medicare PIN