Provider Demographics
NPI:1417199274
Name:BARNES, MATTHEW M (PT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:M
Last Name:BARNES
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 1:950 HERNDON PKWY STE 425
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-5537
Mailing Address - Country:US
Mailing Address - Phone:703-665-1444
Mailing Address - Fax:703-972-2729
Practice Address - Street 1:950 HERNDON PKWY STE 425
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-5537
Practice Address - Country:US
Practice Address - Phone:703-665-1444
Practice Address - Fax:703-972-2729
Is Sole Proprietor?:No
Enumeration Date:2009-03-25
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV002380225100000X
VA2305205764225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA233420ZBPFMedicare PIN