Provider Demographics
NPI:1982095402
Name:BURRESS, MATTHEW G (PT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:G
Last Name:BURRESS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5252 LYNGATE CT
Mailing Address - Street 2:STE 203
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-1672
Mailing Address - Country:US
Mailing Address - Phone:703-239-2300
Mailing Address - Fax:703-239-2301
Practice Address - Street 1:456 CHARLES H DIMMOCK PKWY
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-2936
Practice Address - Country:US
Practice Address - Phone:804-520-8366
Practice Address - Fax:804-520-8368
Is Sole Proprietor?:No
Enumeration Date:2015-02-06
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305209263225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAK949 - 0076OtherCAREFIRST
VA2307001177OtherDIRECT ACCESS CERTIFICATION