Healthcare Provider Details

I. General information

NPI: 1336236942
Provider Name (Legal Business Name): MATTHEW MURPHY PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 10/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 ADAMS AVE
SCRANTON PA
18509-1599
US

IV. Provider business mailing address

2010 ADAMS AVE
SCRANTON PA
18509-1599
US

V. Phone/Fax

Practice location:
  • Phone: 570-963-1278
  • Fax: 570-963-1292
Mailing address:
  • Phone: 570-963-1278
  • Fax: 570-963-1292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT010938L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0017622670002
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: