Provider Demographics
NPI:1750472130
Name:SOOTER, MATT ALLEN (PT)
Entity Type:Individual
Prefix:MR
First Name:MATT
Middle Name:ALLEN
Last Name:SOOTER
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 1:4350 S NATIONAL AVE
Mailing Address - Street 2:SUITE A108
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65810-2607
Mailing Address - Country:US
Mailing Address - Phone:417-823-8670
Mailing Address - Fax:417-823-8625
Practice Address - Street 1:4350 S NATIONAL AVE
Practice Address - Street 2:SUITE A108
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65810-2607
Practice Address - Country:US
Practice Address - Phone:417-823-8670
Practice Address - Fax:417-823-8625
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO112478225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist