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General NPI Number Information
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NPI Number | 1811441207
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Entity Type | Individual
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Provider Name | MATTHEW WAIDLER DPT
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Gender | Male
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Dates
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Enumeration Date | 08/15/2016
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Last Update Date | 08/15/2016
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Provider Practice Location Address
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Address Line | 22 MILL ST SUITE 406
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City | ARLINGTON
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State | MA
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Zip | 02476-4784
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Country | US
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Telephone | 781-646-8440
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Fax | 781-643-7542
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Provider Business Mailing Address
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Address Line | 1 CREDIT UNION WAY FL3
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City | RANDOLPH
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State | MA
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Zip | 02368-4633
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Country | US
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Telephone | 781-961-3370
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Fax | 781-961-1291
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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 | 22204
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License Number State | MA
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