Basic Information
Provider Information
NPI: 1013365386
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCHUMACHER
FirstName: MATTHEW
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2360 MULLAN RD STE C
Address2:  
City: MISSOULA
State: MT
PostalCode: 598081811
CountryCode: US
TelephoneNumber: 4067214436
FaxNumber:  
Practice Location
Address1: 2360 MULLAN RD STE C
Address2:  
City: MISSOULA
State: MT
PostalCode: 598081811
CountryCode: US
TelephoneNumber: 4067214436
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/27/2016
LastUpdateDate: 05/27/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2251X0800X1921NDY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic

No ID Information.


Home