Provider Demographics
NPI:1952407447
Name:SPEARS, MATTHEW DYLAN (MSPT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DYLAN
Last Name:SPEARS
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3341 S ELM PL
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-7924
Mailing Address - Country:US
Mailing Address - Phone:918-449-1332
Mailing Address - Fax:
Practice Address - Street 1:3341 S ELM PL
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-7924
Practice Address - Country:US
Practice Address - Phone:918-449-1332
Practice Address - Fax:918-449-8732
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1169942225100000X
OK4079225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist