Provider Demographics
NPI:1750539623
Name:COLVIN, MATTHEW ALLAN (PT)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:ALLAN
Last Name:COLVIN
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 1:473 BRACKENWOOD LN N
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-9026
Mailing Address - Country:US
Mailing Address - Phone:318-344-8846
Mailing Address - Fax:
Practice Address - Street 1:473 BRACKENWOOD LN N
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33418-9026
Practice Address - Country:US
Practice Address - Phone:318-344-8846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13682225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist