Provider Demographics
NPI:1972901726
Name:BOILLAT, MATTHEW (MA, ATC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:BOILLAT
Suffix:
Gender:M
Credentials:MA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 CROSS RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01247-4618
Mailing Address - Country:US
Mailing Address - Phone:413-652-0548
Mailing Address - Fax:
Practice Address - Street 1:375 CHURCH ST
Practice Address - Street 2:
Practice Address - City:NORTH ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01247-4124
Practice Address - Country:US
Practice Address - Phone:413-662-5414
Practice Address - Fax:413-662-5357
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17412255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer