Healthcare Provider Details

I. General information

NPI: 1821756610
Provider Name (Legal Business Name): MATTHEW ALLEN CUOMO DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2021
Last Update Date: 02/16/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 GROW AVE
MONTROSE PA
18801-1105
US

IV. Provider business mailing address

350 NEW FIDELITY CT
GARNER NC
27529-2665
US

V. Phone/Fax

Practice location:
  • Phone: 570-278-1101
  • Fax:
Mailing address:
  • Phone: 919-258-2714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT030157
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: