Provider Demographics
NPI:1144249723
Name:WHALEN, MATTHEW PAUL (LAT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:PAUL
Last Name:WHALEN
Suffix:
Gender:M
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 LINCOLN ST
Mailing Address - Street 2:17
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-2195
Mailing Address - Country:US
Mailing Address - Phone:781-239-5687
Mailing Address - Fax:
Practice Address - Street 1:WEBSTER CENTER
Practice Address - Street 2:BABSON COLLEGE
Practice Address - City:BABSON PARK
Practice Address - State:MA
Practice Address - Zip Code:02457-2195
Practice Address - Country:US
Practice Address - Phone:781-239-5687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16682255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer