MEDICARE: MATTHEW BEACH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	8052147-4701	UT
2	225200000X	Physical Therapy Assistant	8052147-2402	UT

General Provider Information

NPI Number	:	1023830841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW BEACH

Provider Business Mailing Address
First Line	:	1300 HOBBLE CREEK DR
Second Line	:
City	:	SPRINGVILLE
State	:	UT
Zip	:	84663-2854
Country	:	US
Telephone Number	:	801-703-7536
Fax Number	:

Provider Business Practice Location Address
First Line	:	1787 E FORT UNION BLVD STE 101
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-2868
Country	:	US
Telephone Number	:	385-526-3945
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2024
Last Update Date	:	10/31/2024

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Directions to “ MATTHEW BEACH ” Practice Location

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