Healthcare Provider Details

I. General information

NPI: 1235109885
Provider Name (Legal Business Name): RONALD JASON MATTHEWS MSPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 152ND AVE NE
REDMOND WA
98052-5543
US

IV. Provider business mailing address

PO BOX 34584
SEATTLE WA
98124-1584
US

V. Phone/Fax

Practice location:
  • Phone: 425-883-5421
  • Fax:
Mailing address:
  • Phone: 509-241-7349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00010334
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number2305203446
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: