Provider Demographics
NPI:1760132526
Name:FITTS, MATTHEW PHILLIP
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:PHILLIP
Last Name:FITTS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27400 245TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-2001
Mailing Address - Country:US
Mailing Address - Phone:253-486-4249
Mailing Address - Fax:
Practice Address - Street 1:27400 245TH AVE SE
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-2001
Practice Address - Country:US
Practice Address - Phone:253-486-4249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer