Provider Demographics
NPI:1083606966
Name:WESTON, MATTHEW T (MS, PT)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:T
Last Name:WESTON
Suffix:
Gender:M
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 116TH AVE NE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3034
Mailing Address - Country:US
Mailing Address - Phone:425-450-9801
Mailing Address - Fax:425-450-9778
Practice Address - Street 1:1605 116TH AVE NE
Practice Address - Street 2:SUITE 110
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3034
Practice Address - Country:US
Practice Address - Phone:425-450-9801
Practice Address - Fax:425-450-9778
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008929225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8413890Medicaid
WA8858717Medicare ID - Type Unspecified