Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 1133 | NH |
NPI | 1003241423 |
---|---|
Provider Name | Matt Sheaff |
First Address | Lebanon, NH 03766-1903 |
Second Address | Lebanon, NH 03766-1937 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2013 |
Last Update Date | 04/09/2013 |