MEDICARE: MATTHEW SIHOMBING

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	54039	CA

General Provider Information

NPI Number	:	1902783756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW SIHOMBING

Provider Business Mailing Address
First Line	:	1471 CORAL TREE LN
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92408-3642
Country	:	US
Telephone Number	:	909-801-1891
Fax Number	:

Provider Business Practice Location Address
First Line	:	1471 CORAL TREE LN
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92408-3642
Country	:	US
Telephone Number	:	909-801-1891
Fax Number	:

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

Provider Enumeration Date	:	08/20/2025
Last Update Date	:	08/20/2025

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