Provider Demographics
NPI:1851406193
Name:DEGARMO, MATTHEW CARLTON (PT, MBA)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:CARLTON
Last Name:DEGARMO
Suffix:
Gender:M
Credentials:PT, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 91
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:WV
Mailing Address - Zip Code:26426-7313
Mailing Address - Country:US
Mailing Address - Phone:304-782-1285
Mailing Address - Fax:304-269-8187
Practice Address - Street 1:230 HOSPITAL PLZ
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WV
Practice Address - Zip Code:26452-8558
Practice Address - Country:US
Practice Address - Phone:304-269-8097
Practice Address - Fax:304-269-8187
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV001437225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist