Provider Demographics
NPI:1477853323
Name:DAVID, MARIA C (PT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:C
Last Name:DAVID
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 THREE GAIT TRL
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23453-2501
Mailing Address - Country:US
Mailing Address - Phone:757-453-6608
Mailing Address - Fax:
Practice Address - Street 1:5417 WESLEYAN DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-6922
Practice Address - Country:US
Practice Address - Phone:757-490-0736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-26
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032120225100000X
VA2305206821225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist