Basic Information
Provider Information
NPI: 1194874719
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HATSCHER
FirstName: MATTHEW
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: P.T.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 12121 HARBOUR REACH DR STE 100
Address2:  
City: MUKILTEO
State: WA
PostalCode: 982755314
CountryCode: US
TelephoneNumber: 4254938313
FaxNumber: 4254936914
Practice Location
Address1: 12121 HARBOUR REACH DR STE 100
Address2:  
City: MUKILTEO
State: WA
PostalCode: 982755314
CountryCode: US
TelephoneNumber: 4254938313
FaxNumber: 4254939614
Other Information
ProviderEnumerationDate: 01/10/2007
LastUpdateDate: 03/27/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000XPT00008744WAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


Home