Provider Demographics
NPI:1184638231
Name:HARRISON, MATTHEW JOHN (MS, PT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JOHN
Last Name:HARRISON
Suffix:
Gender:M
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 COLETTE DR
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-5833
Mailing Address - Country:US
Mailing Address - Phone:845-463-1325
Mailing Address - Fax:
Practice Address - Street 1:798 ROUTE 9
Practice Address - Street 2:SUITE B
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-1393
Practice Address - Country:US
Practice Address - Phone:845-896-3750
Practice Address - Fax:845-896-5728
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019618225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02278733Medicaid
NYQL8301Medicare ID - Type Unspecified