Provider Demographics
NPI:1821850678
Name:STAMM, MATTHIAS RUSSELL (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MATTHIAS
Middle Name:RUSSELL
Last Name:STAMM
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 BROAD ST APT 2
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02188-4151
Mailing Address - Country:US
Mailing Address - Phone:781-507-1392
Mailing Address - Fax:
Practice Address - Street 1:1333 MAIN ST STE G
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-1756
Practice Address - Country:US
Practice Address - Phone:508-500-6815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA27254225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist