MEDICARE: MR. MATT A SHEEHAN PT

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	225100000X	Physical Therapist	27125	CA

General Provider Information

NPI Number	:	1326091596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MATT A SHEEHAN PT

Provider Business Mailing Address
First Line	:	1952 DELLA VERONA DR
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95747-3504
Country	:	US
Telephone Number	:	916-915-7125
Fax Number	:

Provider Business Practice Location Address
First Line	:	10100 TRINITY PKWY # 435
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95219-7238
Country	:	US
Telephone Number	:	209-474-7881
Fax Number	:

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

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	09/17/2019

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