Provider Demographics
NPI:1083767701
Name:PLUME, MATTHEW S (PT)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:S
Last Name:PLUME
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 1:1200 GOUGH ST
Mailing Address - Street 2:#4C
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-6649
Mailing Address - Country:US
Mailing Address - Phone:415-623-8085
Mailing Address - Fax:
Practice Address - Street 1:150 PORTOLA ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94028
Practice Address - Country:US
Practice Address - Phone:650-851-1145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT29316225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA056674Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER