Healthcare Provider Details

I. General information

NPI: 1578483145
Provider Name (Legal Business Name): MATTHEW FEATHERLIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 WATSON ST
LODI CA
95240-4825
US

IV. Provider business mailing address

3663 ARCH RD
STOCKTON CA
95215-8355
US

V. Phone/Fax

Practice location:
  • Phone: 925-341-1231
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: