Provider Demographics
NPI:1356335160
Name:ST THOMAS, MATTHEW FRANCIS (ATC)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:FRANCIS
Last Name:ST THOMAS
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 1:12 SEPTEMBER WAY
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3318
Mailing Address - Country:US
Mailing Address - Phone:860-490-1293
Mailing Address - Fax:860-409-9126
Practice Address - Street 1:200 W MAIN ST
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3638
Practice Address - Country:US
Practice Address - Phone:860-409-9125
Practice Address - Fax:860-409-9126
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer