Provider Demographics
NPI:1295045524
Name:GRIFFIN, MATTHEW S (PT)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:S
Last Name:GRIFFIN
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 1:1666 MOUNT HOPE AVE
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-1302
Mailing Address - Country:US
Mailing Address - Phone:570-622-2525
Mailing Address - Fax:570-628-4572
Practice Address - Street 1:1666 MOUNT HOPE AVE
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-1302
Practice Address - Country:US
Practice Address - Phone:570-622-2525
Practice Address - Fax:570-628-4572
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT020989225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist