Provider Demographics
NPI:1538252366
Name:PENDLETON, MATTHEW BRIAN (MED, ATC)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:BRIAN
Last Name:PENDLETON
Suffix:
Gender:M
Credentials:MED, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 CHRISTIAN ST
Mailing Address - Street 2:SPORTS MEDICINE DEPARTMENT
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-3818
Mailing Address - Country:US
Mailing Address - Phone:203-697-2441
Mailing Address - Fax:
Practice Address - Street 1:333 CHRISTIAN ST
Practice Address - Street 2:SPORTS MEDICINE DEPARTMENT
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-3818
Practice Address - Country:US
Practice Address - Phone:203-697-2441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer