Provider Demographics
NPI:1225136914
Name:MCFADDEN, MATTHEW THOMAS
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:THOMAS
Last Name:MCFADDEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7402 WESTSHIRE DR STE 105
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-8687
Mailing Address - Country:US
Mailing Address - Phone:517-853-6800
Mailing Address - Fax:517-853-6801
Practice Address - Street 1:7402 WESTSHIRE DR STE 105
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-8687
Practice Address - Country:US
Practice Address - Phone:517-853-6800
Practice Address - Fax:517-853-6801
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011950225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6400940OtherPHP
MI30364OtherBCBS
MI6400940OtherPHP