Provider Demographics
NPI:1093561854
Name:MASSEY, MATTHEW A (DPT)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:A
Last Name:MASSEY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5675 ROE BLVD STE 240
Mailing Address - Street 2:
Mailing Address - City:ROELAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66205-2515
Mailing Address - Country:US
Mailing Address - Phone:913-632-4750
Mailing Address - Fax:913-320-0302
Practice Address - Street 1:5675 ROE BLVD STE 240
Practice Address - Street 2:
Practice Address - City:ROELAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66205-2515
Practice Address - Country:US
Practice Address - Phone:913-632-4750
Practice Address - Fax:913-320-0302
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-07117225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist