Provider Demographics
NPI:1457335473
Name:SHEDLOCK, MATTHEW P (PT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:P
Last Name:SHEDLOCK
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 1:2587A GROUSE RDG
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-7945
Mailing Address - Country:US
Mailing Address - Phone:724-940-9347
Mailing Address - Fax:
Practice Address - Street 1:201 N CRAIG ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-1567
Practice Address - Country:US
Practice Address - Phone:412-622-7522
Practice Address - Fax:412-622-7834
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT013135225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist