Provider Demographics
NPI:1902166713
Name:SOMMER, MATHEW PHILLIP (PTA)
Entity Type:Individual
Prefix:MR
First Name:MATHEW
Middle Name:PHILLIP
Last Name:SOMMER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 W ARCH STREET
Mailing Address - Street 2:
Mailing Address - City:IRONWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49938
Mailing Address - Country:US
Mailing Address - Phone:701-552-2798
Mailing Address - Fax:
Practice Address - Street 1:1310 E CLOVERLAND DR
Practice Address - Street 2:
Practice Address - City:IRONWOOD
Practice Address - State:MI
Practice Address - Zip Code:49938-1606
Practice Address - Country:US
Practice Address - Phone:906-932-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-26
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND0844225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant