Provider Demographics
NPI:1073775755
Name:SCHMIDT, MATTHEW JUSTIN (PT)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:JUSTIN
Last Name:SCHMIDT
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 1:141 S BLACK HORSE PIKE
Mailing Address - Street 2:SUITE #3
Mailing Address - City:BLACKWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-2975
Mailing Address - Country:US
Mailing Address - Phone:856-227-3215
Mailing Address - Fax:856-232-3190
Practice Address - Street 1:141 S BLACK HORSE PIKE
Practice Address - Street 2:SUITE #3
Practice Address - City:BLACKWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08012-2975
Practice Address - Country:US
Practice Address - Phone:856-227-3215
Practice Address - Fax:856-232-3190
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00402300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000458043OtherBLUE CROSS/BLUE SHIELD
NJ0106235OtherAMERIHEALTH
PA0106235OtherAMERIHEALTH
NJ000458043OtherBLUE CROSS/BLUE SHIELD
NJ0106235OtherAETNA
PA0106235OtherAETNA
PENDINGMedicare UPIN