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Individual

MRS. KIMBERLY RENE MATUSEVICH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MPT, CLT

Contact information

Practice address
1901 S MAIN ST, SUITE 8, BLACKSBURG, VA 24060-6600
(540) 552-2294
(540) 552-2296
Mailing address
1901 S MAIN ST, SUITE 8, BLACKSBURG, VA 24060-6600
(540) 552-2294
(540) 552-2296

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305005833
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
106123
ANTHEM-BLACKSBURG OFFICE
VA
01
369793
MAMSI
VA
01
7525558
AETNA
VA
01
P00360698
MEDICARE RAILROAD
VA
Enumeration date
10/11/2005
Last updated
04/01/2008
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