Provider Demographics
NPI:1285657205
Name:MANDSAGER, MATTHEW DAVID (MPT)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:DAVID
Last Name:MANDSAGER
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4492 FOOTHILLS DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-3567
Mailing Address - Country:US
Mailing Address - Phone:970-391-2262
Mailing Address - Fax:970-669-7262
Practice Address - Street 1:4492 FOOTHILLS DR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-3567
Practice Address - Country:US
Practice Address - Phone:970-391-2262
Practice Address - Fax:970-669-7262
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7286225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO552898Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER