Provider Demographics
NPI:1669913679
Name:MATT ANDREWS PHYSICAL THERAPY
Entity type:Organization
Organization Name:MATT ANDREWS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:570-525-3945
Mailing Address - Street 1:PO BOX 373
Mailing Address - Street 2:
Mailing Address - City:EAGLES MERE
Mailing Address - State:PA
Mailing Address - Zip Code:17731-0373
Mailing Address - Country:US
Mailing Address - Phone:570-525-3945
Mailing Address - Fax:570-525-3954
Practice Address - Street 1:14029 ROUTE 42
Practice Address - Street 2:
Practice Address - City:MUNCY VALLEY
Practice Address - State:PA
Practice Address - Zip Code:17758
Practice Address - Country:US
Practice Address - Phone:570-525-3945
Practice Address - Fax:570-525-3954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-10
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT07995L261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy