Provider Demographics
NPI:1851926893
Name:BEARDSLEY, MATTHEW ELLISON
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ELLISON
Last Name:BEARDSLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 DENALI ST STE 1
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-4041
Mailing Address - Country:US
Mailing Address - Phone:907-677-6953
Mailing Address - Fax:
Practice Address - Street 1:3210 DENALI STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-4041
Practice Address - Country:US
Practice Address - Phone:907-677-6953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK121823225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist