Provider Demographics
NPI:1811034523
Name:ST. AIMEE, MATTHEW (PT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:ST. AIMEE
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 1:2209 SE 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33035-1354
Mailing Address - Country:US
Mailing Address - Phone:305-230-0384
Mailing Address - Fax:
Practice Address - Street 1:9260 SW 72ND ST
Practice Address - Street 2:SUITE 103
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3275
Practice Address - Country:US
Practice Address - Phone:305-279-6864
Practice Address - Fax:305-279-9837
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT18168225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE8514OtherBCBS FL
FLE8514BMedicare PIN