Provider Demographics
NPI:1578664991
Name:SILKEY, DAVID MATTHEW (MPT, CSCS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MATTHEW
Last Name:SILKEY
Suffix:
Gender:M
Credentials:MPT, CSCS
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 9578
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96158-9578
Mailing Address - Country:US
Mailing Address - Phone:530-543-5896
Mailing Address - Fax:530-544-6512
Practice Address - Street 1:2170 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-7026
Practice Address - Country:US
Practice Address - Phone:530-543-5896
Practice Address - Fax:530-544-6512
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3956225100000X
CA34653225100000X, 225100000X
MN5875225100000X
CAPT34653225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI507668Medicaid
HI507668Medicaid