Provider Demographics
NPI:1982850871
Name:WESTON, MATTHEW LOCKE (PT)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:LOCKE
Last Name:WESTON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 NW 19TH AVE APT 107
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-1391
Mailing Address - Country:US
Mailing Address - Phone:860-335-2543
Mailing Address - Fax:
Practice Address - Street 1:777 NW 19TH AVE APT 107
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1391
Practice Address - Country:US
Practice Address - Phone:860-335-2543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008373225100000X
OR626322251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist