Provider Demographics
NPI:1205859162
Name:STUART, MATTHEW JAMES (PT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JAMES
Last Name:STUART
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 1:9171 BALTIMORE NATIONAL PIKE
Mailing Address - Street 2:STE 120
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-3922
Mailing Address - Country:US
Mailing Address - Phone:410-480-3705
Mailing Address - Fax:410-480-3707
Practice Address - Street 1:9171 BALTIMORE NATIONAL PIKE
Practice Address - Street 2:STE 120
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-3922
Practice Address - Country:US
Practice Address - Phone:410-480-3705
Practice Address - Fax:410-480-3707
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21403225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
J9660004OtherBLUECHOICE
MD65089103OtherCAREFIRST
MD008NR169Medicare PIN