Provider Demographics
NPI:1518744341
Name:HART, MATTHEW D (PT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:D
Last Name:HART
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 1:236 NAUGLER AVE
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-1566
Mailing Address - Country:US
Mailing Address - Phone:978-766-5426
Mailing Address - Fax:
Practice Address - Street 1:313 BOSTON POST RD W STE 160
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-4634
Practice Address - Country:US
Practice Address - Phone:617-982-3805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15848225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist