MEDICARE: MR. MATTHEW SCOTT KEARNS DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	62-032994	NY

General Provider Information

NPI Number	:	1104132455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MATTHEW SCOTT KEARNS DPT

Provider Business Mailing Address
First Line	:	1900 ROUTE 31 STE 12
Second Line	:
City	:	MACEDON
State	:	NY
Zip	:	14502-8943
Country	:	US
Telephone Number	:	315-986-4655
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 ROUTE 31 STE 12
Second Line	:
City	:	MACEDON
State	:	NY
Zip	:	14502-8943
Country	:	US
Telephone Number	:	315-986-4655
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2010
Last Update Date	:	08/25/2010

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