Provider Demographics
NPI:1043555436
Name:SOMERVILLE, MATTHEW T (DPT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:T
Last Name:SOMERVILLE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9218 KIMMER DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LONETREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-6732
Mailing Address - Country:US
Mailing Address - Phone:303-792-7377
Mailing Address - Fax:303-792-9077
Practice Address - Street 1:4284 TRAIL BOSS DR
Practice Address - Street 2:SUITE 130
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-7521
Practice Address - Country:US
Practice Address - Phone:303-663-8086
Practice Address - Fax:303-663-8289
Is Sole Proprietor?:No
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
COPTL0011991225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist