Provider Demographics
NPI:1851143168
Name:EMERICK, MATTHEW (LMT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:EMERICK
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 WESTCHESTER DR STE 4
Mailing Address - Street 2:
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-3994
Mailing Address - Country:US
Mailing Address - Phone:330-793-5555
Mailing Address - Fax:330-793-7649
Practice Address - Street 1:134 WESTCHESTER DR STE 4
Practice Address - Street 2:
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-3994
Practice Address - Country:US
Practice Address - Phone:330-793-5555
Practice Address - Fax:330-793-7649
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH14411225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist