Basic Information
| Provider Information | |||||||||
| NPI: | 1336628791 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SLAYBAUGH | ||||||||
| FirstName: | MATHEW | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 66 N 6TH ST | ||||||||
| Address2: | |||||||||
| City: | POMEROY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993479705 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 66 N 6TH ST | ||||||||
| Address2: | |||||||||
| City: | POMEROY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 993479705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5098431591 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2018 | ||||||||
| LastUpdateDate: | 08/07/2018 | ||||||||
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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 | 60737535 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 60737535 | 01 | WA | PHYSICAL THERAPIST LICENSE | OTHER |