Provider Demographics
NPI:1912211848
Name:SCHNACKENBERG, MATTHEW S (MPT)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:S
Last Name:SCHNACKENBERG
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2296 JOHN ROLFE PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-6913
Mailing Address - Country:US
Mailing Address - Phone:804-741-7077
Mailing Address - Fax:804-741-0377
Practice Address - Street 1:2296 JOHN ROLFE PKWY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-6913
Practice Address - Country:US
Practice Address - Phone:804-741-7077
Practice Address - Fax:804-741-0377
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052064062251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic