Provider Demographics
NPI:1457743239
Name:BENNION, MATTHEW BOYD (DPT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:BOYD
Last Name:BENNION
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:PO BOX 493396
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96049-3396
Mailing Address - Country:US
Mailing Address - Phone:530-221-9952
Mailing Address - Fax:530-221-9910
Practice Address - Street 1:844 BRIDGE ST
Practice Address - Street 2:SUITE C
Practice Address - City:COLUSA
Practice Address - State:CA
Practice Address - Zip Code:95932-2867
Practice Address - Country:US
Practice Address - Phone:530-458-7770
Practice Address - Fax:530-458-7735
Is Sole Proprietor?:No
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT42294225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist