Provider Demographics
NPI:1649684457
Name:HLIVKO, MATHEW JOHN (LMT)
Entity type:Individual
Prefix:MR
First Name:MATHEW
Middle Name:JOHN
Last Name:HLIVKO
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 463
Mailing Address - Street 2:4040 JOHN ST.
Mailing Address - City:RANDOLPH
Mailing Address - State:OH
Mailing Address - Zip Code:44265-0463
Mailing Address - Country:US
Mailing Address - Phone:330-316-4900
Mailing Address - Fax:
Practice Address - Street 1:1485 STATE ROUTE 44
Practice Address - Street 2:
Practice Address - City:ATWATER
Practice Address - State:OH
Practice Address - Zip Code:44201-9267
Practice Address - Country:US
Practice Address - Phone:330-325-7390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-19
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.016683225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist