Healthcare Provider Details

I. General information

NPI: 1952777450
Provider Name (Legal Business Name): MATTHEW HALES DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2015
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

870 N MAIN ST
CLAWSON MI
48017-1550
US

IV. Provider business mailing address

870 N MAIN ST
CLAWSON MI
48017-1550
US

V. Phone/Fax

Practice location:
  • Phone: 248-733-3885
  • Fax: 248-566-0098
Mailing address:
  • Phone: 248-733-3885
  • Fax: 248-566-0098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501016698
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: