Provider Demographics
NPI:1104807288
Name:THESSING, MATTHEW LAWRENCE (PT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:LAWRENCE
Last Name:THESSING
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 E GRACE AVE
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80863-3127
Mailing Address - Country:US
Mailing Address - Phone:719-687-3767
Mailing Address - Fax:719-687-2525
Practice Address - Street 1:406 E GRACE AVE
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863-3127
Practice Address - Country:US
Practice Address - Phone:719-687-3767
Practice Address - Fax:719-687-2525
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7158225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC802561Medicare PIN