Provider Demographics
NPI:1841574761
Name:TRAVER, MATTHEW JOSEPH (DPT, PT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JOSEPH
Last Name:TRAVER
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 BUTLER ST
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-4465
Mailing Address - Country:US
Mailing Address - Phone:570-970-0402
Mailing Address - Fax:570-970-0403
Practice Address - Street 1:182 BUTLER ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-4465
Practice Address - Country:US
Practice Address - Phone:570-970-0402
Practice Address - Fax:570-970-0403
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT021622225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist