Provider Demographics
NPI:1508980004
Name:GAINES, MATTHEW PATTON (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:PATTON
Last Name:GAINES
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:UWMC PHYSICAL THERAPY DEPARTMENT
Mailing Address - Street 2:1959 NE PACIFIC ST.
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-0001
Mailing Address - Country:US
Mailing Address - Phone:206-598-4830
Mailing Address - Fax:206-598-4897
Practice Address - Street 1:UWMC PHYSICAL THERAPY DEPARTMENT
Practice Address - Street 2:1959 NE PACIFIC ST.
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-0001
Practice Address - Country:US
Practice Address - Phone:206-598-4830
Practice Address - Fax:206-598-4897
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020561225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ23L91Medicare ID - Type Unspecified