Provider Demographics
NPI:1437415080
Name:FENSTERMAKER, MATTHEW D (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:D
Last Name:FENSTERMAKER
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 1:1408 LAKE TAPPS PKWY SE
Mailing Address - Street 2:STE E106
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-8158
Mailing Address - Country:US
Mailing Address - Phone:253-939-7179
Mailing Address - Fax:253-939-7182
Practice Address - Street 1:1408 LAKE TAPPS PKWY SE
Practice Address - Street 2:STE E106
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98092-8158
Practice Address - Country:US
Practice Address - Phone:253-939-7179
Practice Address - Fax:253-939-7182
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60266971225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist