Provider Demographics
NPI:1972024495
Name:FIANO, MATTHEW THOMAS (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:THOMAS
Last Name:FIANO
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:752 SOUTHLEAF DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-4749
Mailing Address - Country:US
Mailing Address - Phone:757-285-4226
Mailing Address - Fax:757-466-4404
Practice Address - Street 1:397 LITTLE NECK RD STE 100
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-5764
Practice Address - Country:US
Practice Address - Phone:757-222-2230
Practice Address - Fax:757-227-5460
Is Sole Proprietor?:No
Enumeration Date:2017-07-06
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305211208225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist