MEDICARE: MATTHEW LOUGHEED

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	225200000X	Physical Therapy Assistant	5502003813	MI
2	225200000X	Physical Therapy Assistant	2107543	TX

General Provider Information

NPI Number	:	1790187540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW LOUGHEED

Provider Business Mailing Address
First Line	:	7473 HILL RD
Second Line	:
City	:	SWARTZ CREEK
State	:	MI
Zip	:	48473-7602
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7473 HILL RD
Second Line	:
City	:	SWARTZ CREEK
State	:	MI
Zip	:	48473-7602
Country	:	US
Telephone Number	:	810-919-7370
Fax Number	:

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

Provider Enumeration Date	:	09/24/2014
Last Update Date	:	09/24/2014

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Directions to “ MATTHEW LOUGHEED ” Practice Location

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