Provider Demographics
NPI:1467533489
Name:SPRAGUE, MATTHEW (PT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:SPRAGUE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2237 CROCKER RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-7605
Mailing Address - Country:US
Mailing Address - Phone:440-617-9600
Mailing Address - Fax:440-617-9608
Practice Address - Street 1:2237 CROCKER RD
Practice Address - Street 2:SUITE 110
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-7605
Practice Address - Country:US
Practice Address - Phone:440-617-9600
Practice Address - Fax:440-617-9608
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPT 8234225100000X
OHPT.014160225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOA101674Medicare PIN