Basic Information
| Provider Information | |||||||||
| NPI: | 1386627339 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAROON | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5982 | ||||||||
| Address2: | |||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234710982 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7576230867 | ||||||||
| FaxNumber: | 7576272923 | ||||||||
| Practice Location | |||||||||
| Address1: | 951 W 21ST ST | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235171534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7576230867 | ||||||||
| FaxNumber: | 7576272923 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2005 | ||||||||
| LastUpdateDate: | 10/22/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2305003099 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 010371465 | 05 | VA | MEDICAID | 010371538 | 05 | VA | MEDICAID | 010371571 | 05 | VA | MEDICAID | 010371503 | 05 | VA | MEDICAID | 010371414 | 05 | VA | MEDICAID | 008938857 | 05 | VA | MEDICAID | 1386627339 | 05 | VA | MEDICAID |