Healthcare Provider Details

I. General information

NPI: 1912168204
Provider Name (Legal Business Name): MATTHEW W GEARY PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 11/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 MILL ST
CENTER CONWAY NH
03813-4407
US

IV. Provider business mailing address

PO BOX 2
CENTER CONWAY NH
03813-0002
US

V. Phone/Fax

Practice location:
  • Phone: 207-712-4933
  • Fax:
Mailing address:
  • Phone: 207-712-4933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT3422
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3780
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: