Provider Demographics
NPI:1184788531
Name:GARREAN, MATTHEW J (PT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
Last Name:GARREAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:MATTHEW
Other - Middle Name:J
Other - Last Name:GARREAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 1560
Mailing Address - Street 2:
Mailing Address - City:LAKEPORT
Mailing Address - State:CA
Mailing Address - Zip Code:95453-1560
Mailing Address - Country:US
Mailing Address - Phone:707-263-4564
Mailing Address - Fax:707-263-4572
Practice Address - Street 1:1281 CRAIG AVE
Practice Address - Street 2:
Practice Address - City:LAKEPORT
Practice Address - State:CA
Practice Address - Zip Code:95453-5704
Practice Address - Country:US
Practice Address - Phone:707-263-4564
Practice Address - Fax:707-263-4572
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT29440225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT29440OtherST. LICENSE