Provider Demographics
NPI:1184353328
Name:WILSON, MATTHEW J (ATC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
Last Name:WILSON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3295 N HILLS RD
Mailing Address - Street 2:
Mailing Address - City:MURRYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15668-1319
Mailing Address - Country:US
Mailing Address - Phone:724-422-6649
Mailing Address - Fax:
Practice Address - Street 1:612 SALT ST
Practice Address - Street 2:
Practice Address - City:SALTSBURG
Practice Address - State:PA
Practice Address - Zip Code:15681-1128
Practice Address - Country:US
Practice Address - Phone:724-639-8300
Practice Address - Fax:724-639-3112
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-05
Last Update Date:2022-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0030422255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer