=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740845759
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MATTHEW JOHN COELHO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/06/2019
-----------------------------------------------------
Last Update Date | 05/06/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 74 GRAY RD
-----------------------------------------------------
City | FALMOUTH
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04105-2062
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-797-3006
-----------------------------------------------------
Fax | 207-797-3002
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 73 NEWTON RD UNIT 101
-----------------------------------------------------
City | PLAISTOW
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03865-2440
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-388-7272
-----------------------------------------------------
Fax | 978-388-7373
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT5385
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------