Provider Demographics
NPI:1982255949
Name:OBERMEYER, MATTHEW MARK (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:MARK
Last Name:OBERMEYER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 DARTMOUTH DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4413
Mailing Address - Country:US
Mailing Address - Phone:907-278-9455
Mailing Address - Fax:
Practice Address - Street 1:3890 UNIVERSITY LAKE DR STE 110
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4669
Practice Address - Country:US
Practice Address - Phone:907-562-2277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-21
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK147516225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist