Healthcare Provider Details

I. General information

NPI: 1700751138
Provider Name (Legal Business Name): MATTHEW WOUGHTER RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2025
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33-57 HARRISON ST
JOHNSON CITY NY
13790-2174
US

IV. Provider business mailing address

56 STATE ROUTE 34
WAVERLY NY
14892-9793
US

V. Phone/Fax

Practice location:
  • Phone: 607-761-5006
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number006996
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: