Matthew Donnelly
Individual provider Active NPI Physical Therapy Assistant · Gambrills, MD
NPI 1639623804 · NPPES record last updated Aug 5, 2016
Key facts
- NPI
- 1639623804
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- A4479 (MD)
- Practice address
- 1219 Waugh Chapel Rd
Gambrills, MD 21054-1608 - Phone
- (904) 451-8334
- NPI assigned
- Aug 5, 2016
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A4479 | MD | MD | Physical Therapy Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | A4479 | MD | Yes |
Addresses
Primary practice location
1219 Waugh Chapel Rd
Gambrills, MD 21054-1608
Mailing address
1467 Justin PL
Crofton, MD 21114-2122
Phone (904) 451-8334
Other providers in Gambrills, MD
- Delicate Dental of Maryland, P.C.
- John Victor Demaio
- Dentistry for Children of Maryland, LLC
- Susan Elizabeth Dodge
- Donald R Schneider, MD and Zachary R Schneider, MD PA
- Sara E Donnelly
- Theresa Doyle
- Dr. Olga Baczara
- Terrie Leigh Driscoll
- DRS Ergent Care, LLC
All providers in Gambrills, MD · Physical Therapy Assistant in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 5, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.