=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871095273
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MATHEW ALAN HOARD PT, CBIS, NDT-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/02/2018
-----------------------------------------------------
Last Update Date | 03/02/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3360 HOSPITAL RD
-----------------------------------------------------
City | SAGINAW
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48603-9622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-790-7823
-----------------------------------------------------
Fax | 989-790-7866
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3360 HOSPITAL RD
-----------------------------------------------------
City | SAGINAW
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48603-9622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-790-7823
-----------------------------------------------------
Fax | 989-790-7866
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physical Therapist
-----------------------------------------------------
License Number | 5501011062
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------