Provider Demographics
NPI:1326091596
Name:SHEEHAN, MATT A (PT)
Entity Type:Individual
Prefix:MR
First Name:MATT
Middle Name:A
Last Name:SHEEHAN
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 1:1952 DELLA VERONA DR
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-3504
Mailing Address - Country:US
Mailing Address - Phone:916-915-7125
Mailing Address - Fax:
Practice Address - Street 1:10100 TRINITY PKWY # 435
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-7238
Practice Address - Country:US
Practice Address - Phone:209-474-7881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27125225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT27125OMedicare ID - Type UnspecifiedPPIN