Provider Demographics
NPI:1154077410
Name:CONDAME, MATTHEW JOHN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JOHN
Last Name:CONDAME
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 STATE ROUTE 31 STE 12
Mailing Address - Street 2:
Mailing Address - City:MACEDON
Mailing Address - State:NY
Mailing Address - Zip Code:14502-8943
Mailing Address - Country:US
Mailing Address - Phone:315-986-4655
Mailing Address - Fax:315-986-5901
Practice Address - Street 1:1900 STATE ROUTE 31 STE 12
Practice Address - Street 2:
Practice Address - City:MACEDON
Practice Address - State:NY
Practice Address - Zip Code:14502-8943
Practice Address - Country:US
Practice Address - Phone:315-986-4655
Practice Address - Fax:315-986-5901
Is Sole Proprietor?:No
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist