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NPI Code Detail

MEDICARE: MATTHEW PAUL CONDO DPT

MEDICARE: MATTHEW PAUL CONDO DPT
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
1225100000XPhysical TherapistPT10305OH
2225100000XPhysical TherapistP18349NC

General Provider Information

NPI Number : 1083700413
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW PAUL CONDO DPT
Provider Business Mailing Address
First Line : 1991 FORDHAM DR STE 102
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28304-3774
Country : US
Telephone Number : 910-484-4653
Fax Number : 910-483-9256
Provider Business Practice Location Address
First Line : 1991 FORDHAM DR STE 102
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28304-3774
Country : US
Telephone Number : 910-484-4653
Fax Number : 910-483-9256
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2006
Last Update Date : 09/22/2020

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Practice Location Address:
1991 FORDHAM DR STE 102
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1841141991 — KASSIDI LOGAN BROWN PT
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1457685745 — MR. DAVID JOHANSON DPT
Practice Location Address:
1991 FORDHAM DR STE 102
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28304-3774
Practice Phone: 910-484-4653
Practice Fax: 910-483-9256
1114903564 — MARY M. WALSH OTR/L, CHT
Practice Location Address:
1991 FORDHAM DR STE 102
FAYETTEVILLE, NC
28304-3774
Practice Phone: 910-484-4653
Practice Fax: 910-483-9256
1578505848 — ALICE JEAN MULLHOLAND OTR/L, CHT
Practice Location Address:
1991 FORDHAM DR STE 102
FAYETTEVILLE, NC
28304-3774
Practice Phone: 910-484-4653
Practice Fax: 910-483-9256
1730294745 — MICHAEL S. KIM OTR/L
Practice Location Address:
1991 FORDHAM DR STE 102
FAYETTEVILLE, NC
28304-3774
Practice Phone: 910-484-4653
Practice Fax: 910-483-9256

Directions to “ MATTHEW PAUL CONDO DPT” Practice Location

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