Provider Demographics
NPI:1679238364
Name:SLY, MATTHEW (PTA)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:SLY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2518 HEATHER HILL CT
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-2957
Mailing Address - Country:US
Mailing Address - Phone:972-658-1098
Mailing Address - Fax:
Practice Address - Street 1:375 FM 548
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-6968
Practice Address - Country:US
Practice Address - Phone:972-771-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant