Provider Demographics
NPI:1902036114
Name:DRAKE, MATTHEW C (ATC, CMT)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:C
Last Name:DRAKE
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Gender:M
Credentials:ATC, CMT
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Mailing Address - Street 1:37650 PROFESSIONAL CENTER DR
Mailing Address - Street 2:SUITE 105A
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-1197
Mailing Address - Country:US
Mailing Address - Phone:734-953-1745
Mailing Address - Fax:734-953-1743
Practice Address - Street 1:37650 PROFESSIONAL CENTER DR
Practice Address - Street 2:SUITE 105A
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-1197
Practice Address - Country:US
Practice Address - Phone:734-953-1745
Practice Address - Fax:734-953-1743
Is Sole Proprietor?:No
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist