Healthcare Provider Details

I. General information

NPI: 1154206258
Provider Name (Legal Business Name): MATTHEW DENVER WATKINS-GREENHOLT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2025
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 W HANOVER ST STE 4
SPRING GROVE PA
17362-1148
US

IV. Provider business mailing address

341 COLEMAN RD
GETTYSBURG PA
17325-8243
US

V. Phone/Fax

Practice location:
  • Phone: 717-225-6671
  • Fax:
Mailing address:
  • Phone: 717-440-0105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT033492
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: