Provider Demographics
NPI:1659615813
Name:DAILEY, MATTHEW R (PT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:R
Last Name:DAILEY
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 1:106 SAILORS COVE DR
Mailing Address - Street 2:
Mailing Address - City:PORT ST JOE
Mailing Address - State:FL
Mailing Address - Zip Code:32456-1890
Mailing Address - Country:US
Mailing Address - Phone:850-544-2197
Mailing Address - Fax:850-743-4088
Practice Address - Street 1:106 SAILORS COVE DR
Practice Address - Street 2:
Practice Address - City:PORT ST JOE
Practice Address - State:FL
Practice Address - Zip Code:32456-1890
Practice Address - Country:US
Practice Address - Phone:850-544-2197
Practice Address - Fax:850-743-4088
Is Sole Proprietor?:No
Enumeration Date:2012-11-12
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070018750225100000X
FLPT28304225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist