Provider Demographics
NPI:1154711398
Name:GIORDANELLI, MATTHEW DAVID (PT, DPT, ATC, CSCS)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DAVID
Last Name:GIORDANELLI
Suffix:
Gender:M
Credentials:PT, DPT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 TERRACE AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49802-4224
Mailing Address - Country:US
Mailing Address - Phone:906-396-4352
Mailing Address - Fax:
Practice Address - Street 1:3500 JFK PKWY STE 120
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2635
Practice Address - Country:US
Practice Address - Phone:970-663-6142
Practice Address - Fax:970-488-2850
Is Sole Proprietor?:No
Enumeration Date:2015-01-26
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14228-24225100000X
2255A2300X, 390200000X
CO15739225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program