Individual
MATTHEW A. MAILLOUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT, OCS
Contact information
Practice address
7493 RIGHT FLANK RD STE 410, MECHANICSVILLE, VA 23116-3846
(804) 569-7091
(804) 569-7094
Mailing address
PO BOX 69030, BALTIMORE, MD 21264-9030
(757) 873-2302
(757) 873-2306
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305206966
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1730475260
—
VA
01
—
225579
BCBS (PHYSICAL THERAPY)
VA
Enumeration date
06/23/2011
Last updated
04/27/2018
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