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NPI Code Detail

MEDICARE: MR. MATTHEW LAWRENCE INFANZON PT

MEDICARE:  MR. MATTHEW LAWRENCE INFANZON  PT
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
1225100000XPhysical Therapist1156450TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18T2912OTHERTXPROVIDER'S BCBS OF TX #

General Provider Information

NPI Number : 1346259587
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MATTHEW LAWRENCE INFANZON PT
Provider Business Mailing Address
First Line : 4401 N INTERSTATE 35
Second Line : SUITE 110
City : DENTON
State : TX
Zip : 76207-3432
Country : US
Telephone Number : 940-483-9020
Fax Number :
Provider Business Practice Location Address
First Line : 4401 N INTERSTATE 35
Second Line : SUITE 110
City : DENTON
State : TX
Zip : 76207-3432
Country : US
Telephone Number : 940-483-9020
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/05/2006
Last Update Date : 07/09/2007

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Directions to “ MR. MATTHEW LAWRENCE INFANZON PT” Practice Location

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