Active NPI
Matthew P Brennan, PT, DPT
- Physical Therapist
- Glen Allen, VA
National Provider Identifier
1497981161
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2305206387
- Practice address
- 10128 W Broad St
Forum Building III, Suite K
Glen Allen, VA 23060-6761 - Phone
- (804) 217-9210
- Fax
- (804) 217-9213
- NPI assigned
- Jun 8, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 11681 | NC | |
| Physical Therapist | 225100000X | 2305206387 | VA | Primary |
Addresses
Primary practice location
10128 W Broad St
Forum Building III, Suite K
Glen Allen, VA 23060-6761
Mailing address
771 Pilot House Dr
Newport News, VA 23606-1990
Phone (757) 873-2302
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9223520 | Other | VA | AETNA |
| P00826481 | Other | VA | RAILROAD MEDICARE |
| 192953 | Other | VA | BCBS (PHYSICAL THERAPY) |
| 1497981161 | Medicaid | VA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in DC
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
2708 Rutgers CT
Henrico, VA 23233-1699
PO Box
Suite 290609
Nashville, TN 37229
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11681 | NC | MD | Professional Counselor |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1244419200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1295136000000",
"number": "1497981161",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "771 PILOT HOUSE DR",
"city": "NEWPORT NEWS",
"state": "VA",
"postal_code": "236061990",
"telephone_number": "757-873-2302",
"fax_number": "757-873-2306"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10128 W BROAD ST",
"address_2": "FORUM BUILDING III, SUITE K",
"city": "GLEN ALLEN",
"state": "VA",
"postal_code": "230606761",
"telephone_number": "804-217-9210",
"fax_number": "804-217-9213"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRENNAN",
"first_name": "MATTHEW",
"middle_name": "P",
"credential": "PT, DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-06-08",
"last_updated": "2011-01-16",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NC",
"license": "11681",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "VA",
"license": "2305206387",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "9223520",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00826481",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS (PHYSICAL THERAPY)",
"identifier": "192953",
"state": "VA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1497981161",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Glen Allen, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.