Provider Demographics
NPI:1598205692
Name:FRAWLEY, MATTHEW
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:FRAWLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-7568
Mailing Address - Fax:732-894-9202
Practice Address - Street 1:54 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:WEYERS CAVE
Practice Address - State:VA
Practice Address - Zip Code:24486
Practice Address - Country:US
Practice Address - Phone:542-234-8800
Practice Address - Fax:540-904-0726
Is Sole Proprietor?:No
Enumeration Date:2017-03-08
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01719800225100000X
VA2305213709225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40QA01719800OtherPT LICENSE