Provider Demographics
NPI:1770852246
Name:GEARY, MATTHEW A
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:A
Last Name:GEARY
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 1:5410 ORANGEPORT RD
Mailing Address - Street 2:
Mailing Address - City:BREWERTON
Mailing Address - State:NY
Mailing Address - Zip Code:13029-8744
Mailing Address - Country:US
Mailing Address - Phone:315-668-6340
Mailing Address - Fax:
Practice Address - Street 1:5410 ORANGEPORT RD
Practice Address - Street 2:
Practice Address - City:BREWERTON
Practice Address - State:NY
Practice Address - Zip Code:13029-8744
Practice Address - Country:US
Practice Address - Phone:315-668-6340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11534225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist