Provider Demographics
NPI:1730485111
Name:WYNINGS, MATTHEW JAME (LMT)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:JAME
Last Name:WYNINGS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:MR
Other - First Name:MATTHEW
Other - Middle Name:JAMES
Other - Last Name:WYNINGS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:305 S CHURCH ST STE 115
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-7605
Mailing Address - Country:US
Mailing Address - Phone:570-479-4766
Mailing Address - Fax:570-245-3899
Practice Address - Street 1:305 S CHURCH ST STE 115
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-7605
Practice Address - Country:US
Practice Address - Phone:570-479-4766
Practice Address - Fax:570-245-3899
Is Sole Proprietor?:No
Enumeration Date:2011-02-02
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist