Provider Demographics
NPI:1912168204
Name:GEARY, MATTHEW W (PT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:W
Last Name:GEARY
Suffix:
Gender:M
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:PO BOX 2
Mailing Address - Street 2:
Mailing Address - City:CENTER CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03813-0002
Mailing Address - Country:US
Mailing Address - Phone:207-712-4933
Mailing Address - Fax:
Practice Address - Street 1:63 MILL ST
Practice Address - Street 2:
Practice Address - City:CENTER CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03813-4407
Practice Address - Country:US
Practice Address - Phone:207-712-4933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT3422225100000X
NH3780225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist