Provider Demographics
NPI:1720009699
Name:HARKNESS, MATTHEW KEITH (PT)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:KEITH
Last Name:HARKNESS
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 1:1255 VISCAYA PKWY #1
Mailing Address - Street 2:STE 102
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990
Mailing Address - Country:US
Mailing Address - Phone:239-242-0070
Mailing Address - Fax:239-242-0076
Practice Address - Street 1:1255 VISCAYA PKWY #1
Practice Address - Street 2:STE 102
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990
Practice Address - Country:US
Practice Address - Phone:239-242-0070
Practice Address - Fax:239-242-0076
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19897225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6261Medicare ID - Type Unspecified