Provider Demographics
NPI:1184028052
Name:POWERS, MATTHEW M (PT DPT)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:M
Last Name:POWERS
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 1:12371 HWY 90
Mailing Address - Street 2:STE D
Mailing Address - City:LULING
Mailing Address - State:LA
Mailing Address - Zip Code:70070
Mailing Address - Country:US
Mailing Address - Phone:985-331-1001
Mailing Address - Fax:985-331-1005
Practice Address - Street 1:12371 HWY 90
Practice Address - Street 2:STE D
Practice Address - City:LULING
Practice Address - State:LA
Practice Address - Zip Code:70070
Practice Address - Country:US
Practice Address - Phone:985-331-1001
Practice Address - Fax:985-331-1005
Is Sole Proprietor?:No
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist