Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 15545 | MA |
NPI | 1023013695 |
---|---|
Provider Name | Mr. Matthew John Tibert |
First Address | Franklin, MA 02038-1833 |
Second Address | Franklin, MA 02038-1833 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2005 |
Last Update Date | 03/09/2013 |