Provider Demographics
NPI:1912102377
Name:MATTHEWS, DENISE RAE (PT)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:RAE
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5129 70TH ST
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-6924
Mailing Address - Country:US
Mailing Address - Phone:515-254-0288
Mailing Address - Fax:515-331-6952
Practice Address - Street 1:13731 HICKMAN RD
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50323-2193
Practice Address - Country:US
Practice Address - Phone:515-331-6907
Practice Address - Fax:515-331-6952
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA016332251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics