Basic Information
| Provider Information | |||||||||
| NPI: | 1902869712 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STUTZ | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | REX | ||||||||
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| Credential: | ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2080 NE CHANEL CT | ||||||||
| Address2: | APT 4 | ||||||||
| City: | BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977015371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5404087269 | ||||||||
| FaxNumber: | 5403821681 | ||||||||
| Practice Location | |||||||||
| Address1: | 2200 NE NEFF RD | ||||||||
| Address2: | STE 200 | ||||||||
| City: | BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977014283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413823344 | ||||||||
| FaxNumber: | 5413821681 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | AT-AT-1005249 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.