Provider Demographics
NPI:1205005352
Name:DITZLER, MATTHEW D (DPT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:D
Last Name:DITZLER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17026-9528
Mailing Address - Country:US
Mailing Address - Phone:717-507-5202
Mailing Address - Fax:804-266-5677
Practice Address - Street 1:114 E MAIN ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:PA
Practice Address - Zip Code:17026-9528
Practice Address - Country:US
Practice Address - Phone:717-507-5202
Practice Address - Fax:804-266-5677
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-22
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT019164225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA122504MV7Medicare PIN