Basic Information
| Provider Information | |||||||||
| NPI: | 1669137196 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ESPOSITO | ||||||||
| FirstName: | MATTHEW | ||||||||
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| Credential: | LAT, ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3125 TIDAL BAY LN | ||||||||
| Address2: | |||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234511147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7575755311 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4435 VIRGINIA BEACH BLVD | ||||||||
| Address2: | |||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234623100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7572520590 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2021 | ||||||||
| LastUpdateDate: | 10/31/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 0126003471 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.