Provider Demographics
NPI:1124223524
Name:SHEA, MATTHEW PATRICK (PT)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:PATRICK
Last Name:SHEA
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 1:12525 WINONA CT
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-5773
Mailing Address - Country:US
Mailing Address - Phone:720-565-2693
Mailing Address - Fax:
Practice Address - Street 1:2121 MESA DR
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3621
Practice Address - Country:US
Practice Address - Phone:720-565-2693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8292225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist