Healthcare Provider Details

I. General information

NPI: 1639608623
Provider Name (Legal Business Name): MATT NEUFELD DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2017
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2116 N MCALLISTER AVE
TEMPE AZ
85288-1320
US

IV. Provider business mailing address

3370 N HAYDEN RD STE 123 #732
SCOTTSDALE AZ
85251
US

V. Phone/Fax

Practice location:
  • Phone: 630-995-6910
  • Fax:
Mailing address:
  • Phone: 630-995-6910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number13053
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberLPT-013053
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: