Provider Demographics
NPI:1932825544
Name:BEKEMEYER, MATTHEW CODY (DPT)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:CODY
Last Name:BEKEMEYER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25111 HARBOUR VISTA CIR
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-5127
Mailing Address - Country:US
Mailing Address - Phone:404-345-4096
Mailing Address - Fax:
Practice Address - Street 1:5860 SR-100 E
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164
Practice Address - Country:US
Practice Address - Phone:386-597-1903
Practice Address - Fax:386-246-7985
Is Sole Proprietor?:No
Enumeration Date:2022-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT38425225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist