Provider Demographics
NPI:1356451538
Name:NEIBERG, MATTHEW D (PT)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:D
Last Name:NEIBERG
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 1:13540 W CAMINO DEL SOL STE 6
Mailing Address - Street 2:
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-4435
Mailing Address - Country:US
Mailing Address - Phone:623-556-5013
Mailing Address - Fax:623-556-9290
Practice Address - Street 1:13540 W CAMINO DEL SOL STE 6
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-4435
Practice Address - Country:US
Practice Address - Phone:623-556-5013
Practice Address - Fax:623-556-9290
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5602225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5602OtherLICENSE#