Provider Demographics
NPI:1124340450
Name:TITMUSS, MATTHEW PETER JOSEPH (DPT)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:PETER JOSEPH
Last Name:TITMUSS
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 1:3117 BROADWAY APT 60
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-4660
Mailing Address - Country:US
Mailing Address - Phone:212-203-2671
Mailing Address - Fax:
Practice Address - Street 1:3117 BROADWAY APT 60
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4660
Practice Address - Country:US
Practice Address - Phone:212-203-2671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-01
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031870225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist