Provider Demographics
NPI:1972750701
Name:CAWLEY, MATTHEW LEE (LMT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:LEE
Last Name:CAWLEY
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 1:3421 SW KELLY AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4629
Mailing Address - Country:US
Mailing Address - Phone:503-841-5583
Mailing Address - Fax:
Practice Address - Street 1:3421 SW KELLY AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4629
Practice Address - Country:US
Practice Address - Phone:503-841-5583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10902172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist