Provider Demographics
NPI:1336511799
Name:CAPE, MATTHEW (PTA)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:CAPE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 DOWNS LOOP
Mailing Address - Street 2:
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29631-2035
Mailing Address - Country:US
Mailing Address - Phone:864-722-9059
Mailing Address - Fax:
Practice Address - Street 1:500 DOWNS LOOP
Practice Address - Street 2:
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29631-2035
Practice Address - Country:US
Practice Address - Phone:864-722-9059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-26
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA003677225200000X
SC2696225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant