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General NPI Number Information
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NPI Number | 1073503231
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Entity Type | Individual
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Provider Name | MATTHEW DEXTER P.T.
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Gender | Male
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Dates
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Enumeration Date | 10/27/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 116 EAST AVE SUITE 2
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City | TALLMADGE
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State | OH
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Zip | 44278-2328
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Country | US
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Telephone | 330-633-3656
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Fax | 330-633-3505
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Provider Business Mailing Address
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Address Line | 1333 TONKAWOOD DR
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City | TALLMADGE
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State | OH
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Zip | 44278-2682
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Country | US
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Telephone | 330-630-9327
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Fax | 330-633-3505
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 7554
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License Number State | OH
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