Provider Demographics
NPI:1114073558
Name:MATTHES, FLETCHER REID (LMT)
Entity Type:Individual
Prefix:MR
First Name:FLETCHER
Middle Name:REID
Last Name:MATTHES
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 184
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-0184
Mailing Address - Country:US
Mailing Address - Phone:585-732-2032
Mailing Address - Fax:
Practice Address - Street 1:2200 PENFIELD RD
Practice Address - Street 2:AT LIFETIME FITNESS
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-1711
Practice Address - Country:US
Practice Address - Phone:585-732-2032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017332225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist