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NPI Code Detail

MEDICARE: MATTHEW JACOB DEWAARD

MEDICARE: MATTHEW JACOB DEWAARD
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
1225200000XPhysical Therapy Assistant

General Provider Information

NPI Number : 1568644342
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW JACOB DEWAARD
Provider Business Mailing Address
First Line : 1845 E COLGATE DR
Second Line :
City : TEMPE
State : AZ
Zip : 85283-2205
Country : US
Telephone Number : 480-897-2541
Fax Number : 480-897-2541
Provider Business Practice Location Address
First Line : 1845 E COLGATE DR
Second Line :
City : TEMPE
State : AZ
Zip : 85283-2205
Country : US
Telephone Number : 480-897-2541
Fax Number : 480-897-2541
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/03/2007
Last Update Date : 12/03/2007

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Directions to “ MATTHEW JACOB DEWAARD ” Practice Location

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