Provider Demographics
NPI:1912944281
Name:MACASKILL, MATTHEW ROSS (PT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ROSS
Last Name:MACASKILL
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 1:2373 G RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-9641
Mailing Address - Country:US
Mailing Address - Phone:970-245-0484
Mailing Address - Fax:970-245-0484
Practice Address - Street 1:2373 G RD
Practice Address - Street 2:SUITE 100
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-9641
Practice Address - Country:US
Practice Address - Phone:970-245-0484
Practice Address - Fax:970-245-0484
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5553225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO81282044Medicaid
CO805608OtherMEDICARE, OTHER
CO5553OtherPHYSICAL THERAPIST