Provider Demographics
NPI:1831323583
Name:DWENGER, MATTHEW THOMAS (PT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:THOMAS
Last Name:DWENGER
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 1:18731 ROETTGER RD
Mailing Address - Street 2:
Mailing Address - City:NEW KNOXVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45871-9508
Mailing Address - Country:US
Mailing Address - Phone:419-753-3062
Mailing Address - Fax:
Practice Address - Street 1:18731 ROETTGER RD
Practice Address - Street 2:
Practice Address - City:NEW KNOXVILLE
Practice Address - State:OH
Practice Address - Zip Code:45871-9508
Practice Address - Country:US
Practice Address - Phone:419-753-3062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-11
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH08007225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist