Provider Demographics
NPI:1376219840
Name:MEDEI, MATTHEW COLE (DPT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:COLE
Last Name:MEDEI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 NW 21ST AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:CHIEFLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32626-1978
Mailing Address - Country:US
Mailing Address - Phone:352-493-2999
Mailing Address - Fax:
Practice Address - Street 1:1315 NW 21ST AVE STE 3
Practice Address - Street 2:
Practice Address - City:CHIEFLAND
Practice Address - State:FL
Practice Address - Zip Code:32626-1978
Practice Address - Country:US
Practice Address - Phone:352-493-2999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT37063225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist