Provider Demographics
NPI:1275511297
Name:KLUSMAN, MATTHEW J (PT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
Last Name:KLUSMAN
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 1:10597 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4471
Mailing Address - Country:US
Mailing Address - Phone:513-794-9666
Mailing Address - Fax:513-794-0688
Practice Address - Street 1:10597 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-4471
Practice Address - Country:US
Practice Address - Phone:513-794-9666
Practice Address - Fax:513-794-0688
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH07586225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2208962Medicaid
OH2208962Medicaid
OH4026736Medicare PIN