MEDICARE: MATTHEW THOMAS DWENGER 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	08007	OH

General Provider Information

NPI Number	:	1831323583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW THOMAS DWENGER PT

Provider Business Mailing Address
First Line	:	18731 ROETTGER RD
Second Line	:
City	:	NEW KNOXVILLE
State	:	OH
Zip	:	45871-9508
Country	:	US
Telephone Number	:	419-753-3062
Fax Number	:

Provider Business Practice Location Address
First Line	:	18731 ROETTGER RD
Second Line	:
City	:	NEW KNOXVILLE
State	:	OH
Zip	:	45871-9508
Country	:	US
Telephone Number	:	419-753-3062
Fax Number	:

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

Provider Enumeration Date	:	05/11/2009
Last Update Date	:	05/11/2009

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