Provider Demographics
NPI:1255196804
Name:MESSNER, MATTHEW (PT, DPT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:MESSNER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 YOSEMITE CIR
Mailing Address - Street 2:
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716-4118
Mailing Address - Country:US
Mailing Address - Phone:201-655-3852
Mailing Address - Fax:
Practice Address - Street 1:47 HEISSER LN
Practice Address - Street 2:
Practice Address - City:SOUTH FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-3314
Practice Address - Country:US
Practice Address - Phone:516-665-0882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052090225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist