1952814451 NPI number — MATTHEW D SUBLER PT, AT

Table of content: MATTHEW D SUBLER PT, AT (NPI 1952814451)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952814451 NPI number — MATTHEW D SUBLER PT, AT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUBLER
Provider First Name:
MATTHEW
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT, AT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952814451
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8906 PITSENBARGER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VERSAILLES
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45380-9713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-621-5891
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
216 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLDWATER
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45828-1703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-763-1464
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/07/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 019850 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1952814451 . This is a "ATC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com