Provider Demographics
NPI:1386627339
Name:MAROON, ROBERT J (PT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:J
Last Name:MAROON
Suffix:
Gender:M
Credentials:PT
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 5982
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23471-0982
Mailing Address - Country:US
Mailing Address - Phone:757-623-0867
Mailing Address - Fax:757-627-2923
Practice Address - Street 1:951 W 21ST ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-1534
Practice Address - Country:US
Practice Address - Phone:757-623-0867
Practice Address - Fax:757-627-2923
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305003099225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010371465Medicaid
VA010371538Medicaid
VA010371571Medicaid
VA010371503Medicaid
VA010371414Medicaid
VA008938857Medicaid
VA1386627339Medicaid
VA010371538Medicaid