Provider Demographics
NPI:1407859515
Name:CARL, MATTHEW ROBERT (MSPT)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:ROBERT
Last Name:CARL
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:45 NOOSENECK HILL RD
Mailing Address - Street 2:UNIT 12
Mailing Address - City:WEST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02817-1564
Mailing Address - Country:US
Mailing Address - Phone:401-385-9530
Mailing Address - Fax:401-385-9532
Practice Address - Street 1:28 NOOSENECK HILL RD
Practice Address - Street 2:UNIT 3
Practice Address - City:WEST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02817-1568
Practice Address - Country:US
Practice Address - Phone:401-385-9530
Practice Address - Fax:401-385-9532
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA16252225100000X
RIPT01649225100000X
CT008064225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI27681-4OtherBLUE CROSS RI
RI408727OtherBLUE CHIP RI
RI201145301OtherUNITED HEALTHCARE
RI3561754OtherAETNA HMO/QPOS
RI7493581OtherAETNA TRAD CHOICE PPO POS
RI709003622Medicare ID - Type Unspecified