Provider Demographics
NPI:1780080176
Name:MATSON, MARIA (PT, DPT)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:MATSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:SANCEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:520 N CANYON ST
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-2320
Mailing Address - Country:US
Mailing Address - Phone:605-642-7996
Mailing Address - Fax:605-642-5955
Practice Address - Street 1:520 N CANYON ST
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-2320
Practice Address - Country:US
Practice Address - Phone:605-642-7996
Practice Address - Fax:605-642-5955
Is Sole Proprietor?:No
Enumeration Date:2014-11-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR 60321225100000X
SD2096225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0394979OtherWA L&I
ORR187561Medicare PIN
ORR178537Medicare PIN