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General NPI Number Information
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NPI Number | 1902166713
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Entity Type | Individual
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Provider Name | MATHEW PHILLIP SOMMER PTA
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Gender | Male
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Dates
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Enumeration Date | 05/26/2012
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Last Update Date | 07/10/2012
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Provider Practice Location Address
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Address Line | 1310 E CLOVERLAND DR
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City | IRONWOOD
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State | MI
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Zip | 49938-1606
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Country | US
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Telephone | 906-932-4200
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Fax |
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Provider Business Mailing Address
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Address Line | 138 W ARCH STREET
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City | IRONWOOD
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State | MI
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Zip | 49938
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Country | US
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Telephone | 701-552-2798
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Fax |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 0844
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License Number State | ND
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