Provider Demographics
NPI:1386019669
Name:ROBERTSON, MATTHEW (PT DPT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 HART ST
Mailing Address - Street 2:
Mailing Address - City:SHEPPARD AFB
Mailing Address - State:TX
Mailing Address - Zip Code:76311-3430
Mailing Address - Country:US
Mailing Address - Phone:940-676-6504
Mailing Address - Fax:
Practice Address - Street 1:149 HART ST
Practice Address - Street 2:
Practice Address - City:SHEPPARD AFB
Practice Address - State:TX
Practice Address - Zip Code:76311-3430
Practice Address - Country:US
Practice Address - Phone:940-676-6504
Practice Address - Fax:940-676-3017
Is Sole Proprietor?:No
Enumeration Date:2015-12-11
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12629022251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic