Provider Demographics
NPI:1407554447
Name:SLATER, MATHEW ALAN (DPT)
Entity Type:Individual
Prefix:
First Name:MATHEW
Middle Name:ALAN
Last Name:SLATER
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 1:1601 SW LANE ST
Mailing Address - Street 2:STEM 101
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604
Mailing Address - Country:US
Mailing Address - Phone:785-233-5500
Mailing Address - Fax:
Practice Address - Street 1:1601 SW LANE ST
Practice Address - Street 2:STEM 101
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-6660
Practice Address - Country:US
Practice Address - Phone:785-233-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-07250261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy