Provider Demographics
NPI:1811430788
Name:ESRICK, MATT (PT, DPT,MBA,A-RSP)
Entity type:Individual
Prefix:
First Name:MATT
Middle Name:
Last Name:ESRICK
Suffix:
Gender:M
Credentials:PT, DPT,MBA,A-RSP
Other - Prefix:
Other - First Name:MATTHEW
Other - Middle Name:R
Other - Last Name:ESRICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT, DPT,MBA,A-RSP
Mailing Address - Street 1:2100 MIDDLE COUNTRY RD
Mailing Address - Street 2:SUITE 17 LOWER LEVEL
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-3577
Mailing Address - Country:US
Mailing Address - Phone:631-504-0680
Mailing Address - Fax:631-204-6577
Practice Address - Street 1:2100 MIDDLE COUNTRY RD
Practice Address - Street 2:SUITE 17 LOWER LEVEL
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-3577
Practice Address - Country:US
Practice Address - Phone:631-504-0680
Practice Address - Fax:631-204-6577
Is Sole Proprietor?:No
Enumeration Date:2016-11-28
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040927225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist