Provider Demographics
NPI:1265731871
Name:PARRILLO, MATTHEW (DPT)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:PARRILLO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16131 HAMPTON CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-9261
Mailing Address - Country:US
Mailing Address - Phone:845-545-7778
Mailing Address - Fax:
Practice Address - Street 1:16131 HAMPTON CROSSING DR
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-9261
Practice Address - Country:US
Practice Address - Phone:845-545-7778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-22
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009019225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101583100Medicaid