Provider Demographics
NPI:1225328875
Name:MEYER, MATTHEW R (LMT)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:R
Last Name:MEYER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 WEHRLE DR
Mailing Address - Street 2:INSIDE GOLD'S GYM
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-1318
Mailing Address - Country:US
Mailing Address - Phone:716-982-6605
Mailing Address - Fax:
Practice Address - Street 1:770 WEHRLE DR
Practice Address - Street 2:INSIDE GOLD'S GYM
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-1318
Practice Address - Country:US
Practice Address - Phone:716-982-6605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-17
Last Update Date:2011-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014465225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist