Provider Demographics
NPI:1033384300
Name:FEA, MATTHEW GERARD (PT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:GERARD
Last Name:FEA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-3340
Mailing Address - Country:US
Mailing Address - Phone:704-642-1102
Mailing Address - Fax:
Practice Address - Street 1:720 GROVE ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-3340
Practice Address - Country:US
Practice Address - Phone:704-642-1102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2182225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist