Healthcare Provider Details

I. General information

NPI: 1770230047
Provider Name (Legal Business Name): MATTHEW WINES DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2022
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8609 EVERGREEN WAY
EVERETT WA
98208-2619
US

IV. Provider business mailing address

8609 EVERGREEN WAY
EVERETT WA
98208-2619
US

V. Phone/Fax

Practice location:
  • Phone: 425-789-3700
  • Fax: 425-789-3750
Mailing address:
  • Phone: 425-789-3700
  • Fax: 425-789-3750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT61232414
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: