Provider Demographics
NPI:1497941801
Name:ANDERSON, MATTHEW E (PT)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:E
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:7571 STATE ROUTE 54
Mailing Address - Street 2:IRA DAVENPORT MEMORIAL HOSPITAL, REHAB SERVICES DEPART
Mailing Address - City:BATH
Mailing Address - State:NY
Mailing Address - Zip Code:14810-9504
Mailing Address - Country:US
Mailing Address - Phone:607-776-8543
Mailing Address - Fax:607-776-8635
Practice Address - Street 1:7571 STATE ROUTE 54
Practice Address - Street 2:IRA DAVENPORT MEMORIAL HOSPITAL, REHAB SERVICES DEPART
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810-9504
Practice Address - Country:US
Practice Address - Phone:607-776-8543
Practice Address - Fax:607-776-8635
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY029672-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist