Provider Demographics
NPI:1679898530
Name:WEIR, MATTHEW A (PT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:A
Last Name:WEIR
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 1:279 DALTON AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-3540
Mailing Address - Country:US
Mailing Address - Phone:413-442-7337
Mailing Address - Fax:413-447-3882
Practice Address - Street 1:279 DALTON AVE
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-3540
Practice Address - Country:US
Practice Address - Phone:413-442-7337
Practice Address - Fax:413-447-3882
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18862225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist