Provider Demographics
NPI:1770073785
Name:JEPPSON, MATTHEW POWELL (DPT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:POWELL
Last Name:JEPPSON
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 745
Mailing Address - Street 2:
Mailing Address - City:BLANDING
Mailing Address - State:UT
Mailing Address - Zip Code:84511-0745
Mailing Address - Country:US
Mailing Address - Phone:435-678-3669
Mailing Address - Fax:435-678-3769
Practice Address - Street 1:802 S 200 W
Practice Address - Street 2:
Practice Address - City:BLANDING
Practice Address - State:UT
Practice Address - Zip Code:84511-3910
Practice Address - Country:US
Practice Address - Phone:435-678-3869
Practice Address - Fax:435-678-3769
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-15
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8143066-24012251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic