Provider Demographics
NPI:1750809455
Name:BLICK, MATTHEW DWAYNE (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DWAYNE
Last Name:BLICK
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3272
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48605-3272
Mailing Address - Country:US
Mailing Address - Phone:989-797-1400
Mailing Address - Fax:989-797-4077
Practice Address - Street 1:331 E WRIGHT AVE
Practice Address - Street 2:
Practice Address - City:SHEPHERD
Practice Address - State:MI
Practice Address - Zip Code:48883-8065
Practice Address - Country:US
Practice Address - Phone:989-567-1300
Practice Address - Fax:989-567-1301
Is Sole Proprietor?:No
Enumeration Date:2017-09-01
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501018295225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist