Provider Demographics
NPI:1558429878
Name:CAPPIS, MATTHEW DIRK (PT)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:DIRK
Last Name:CAPPIS
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:PO BOX 1546
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59403-1546
Mailing Address - Country:US
Mailing Address - Phone:406-727-2739
Mailing Address - Fax:406-453-0959
Practice Address - Street 1:3511 1ST AVE N
Practice Address - Street 2:SUITE 3
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-3527
Practice Address - Country:US
Practice Address - Phone:406-727-2739
Practice Address - Fax:406-453-0959
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT805225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0348041Medicaid
MT000050523Medicare PIN