Healthcare Provider Details

I. General information

NPI: 1255196804
Provider Name (Legal Business Name): MATTHEW MESSNER PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 HEISSER LN
SOUTH FARMINGDALE NY
11735-3314
US

IV. Provider business mailing address

7 YOSEMITE CIR
BOHEMIA NY
11716-4118
US

V. Phone/Fax

Practice location:
  • Phone: 516-665-0882
  • Fax:
Mailing address:
  • Phone: 201-655-3852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number052090
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: