Provider Demographics
NPI:1487600383
Name:YGLESIAS, MATTHEW DENHAM (PT)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:DENHAM
Last Name:YGLESIAS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1219 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-2347
Mailing Address - Country:US
Mailing Address - Phone:225-658-7751
Mailing Address - Fax:225-658-7753
Practice Address - Street 1:7648 PICARDY AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4335
Practice Address - Country:US
Practice Address - Phone:225-768-7676
Practice Address - Fax:225-768-7373
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA06917225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4H679Medicare ID - Type Unspecified