Provider Demographics
NPI:1295091890
Name:TRACEY, MATTHEW BENJAMIN (DPT)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:BENJAMIN
Last Name:TRACEY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 W BEAU ST STE B
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-4663
Mailing Address - Country:US
Mailing Address - Phone:724-228-5656
Mailing Address - Fax:242-285-6597
Practice Address - Street 1:351 W BEAU ST STE B
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-4663
Practice Address - Country:US
Practice Address - Phone:242-559-5517
Practice Address - Fax:724-228-5659
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP13634225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist