Basic Information
| Provider Information | |||||||||
| NPI: | 1043555436 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SOMERVILLE | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9218 KIMMER DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LONETREE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801246732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037927377 | ||||||||
| FaxNumber: | 3037929077 | ||||||||
| Practice Location | |||||||||
| Address1: | 4284 TRAIL BOSS DR | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | CASTLE ROCK | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801047521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036638086 | ||||||||
| FaxNumber: | 3036638289 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2012 | ||||||||
| LastUpdateDate: | 12/11/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PTL0011991 | CO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.