Provider Demographics
NPI:1629453188
Name:POMEROY, MATTHEW (PT)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:POMEROY
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 1:6083 S BELLAIRE WAY
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80121-3171
Mailing Address - Country:US
Mailing Address - Phone:303-789-0891
Mailing Address - Fax:
Practice Address - Street 1:469 STATE HIGHWAY 7
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80023-8965
Practice Address - Country:US
Practice Address - Phone:720-777-1340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-27
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0013358225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist