MEDICARE: MR. MATTHEW MCPHERSON P.T.

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	7057	AZ
2	225100000X	Physical Therapist	5501011054	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871573436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MATTHEW MCPHERSON P.T.

Provider Business Mailing Address
First Line	:	4761 LAKE MICHIGAN DR NW
Second Line	:	SUITE A
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49534
Country	:	US
Telephone Number	:	616-392-3197
Fax Number	:	616-392-7959

Provider Business Practice Location Address
First Line	:	4761 LAKE MICHIGAN DR NW
Second Line	:	SUITE A
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49534
Country	:	US
Telephone Number	:	616-791-7025
Fax Number	:	269-686-4264

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

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	05/24/2024

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