Provider Demographics
NPI:1659716454
Name:TRIPP, MATTHEW P (DPT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:P
Last Name:TRIPP
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 ELM ST
Mailing Address - Street 2:UNIT 7
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-3070
Mailing Address - Country:US
Mailing Address - Phone:207-571-3240
Mailing Address - Fax:207-571-3430
Practice Address - Street 1:380 ELM ST
Practice Address - Street 2:UNIT 7
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-3070
Practice Address - Country:US
Practice Address - Phone:207-571-3240
Practice Address - Fax:207-571-3430
Is Sole Proprietor?:No
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist