Provider Demographics
NPI:1194752907
Name:MIDKIFF, MATTHEW ALLAN GRAYSON (PT DPT CSCS)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ALLAN GRAYSON
Last Name:MIDKIFF
Suffix:
Gender:M
Credentials:PT DPT CSCS
Other - Prefix:
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Mailing Address - Street 1:825 E WARNER RD
Mailing Address - Street 2:STE C-100
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-0994
Mailing Address - Country:US
Mailing Address - Phone:480-722-0300
Mailing Address - Fax:480-722-0302
Practice Address - Street 1:825 E WARNER RD
Practice Address - Street 2:STE C-100
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-0994
Practice Address - Country:US
Practice Address - Phone:480-722-0300
Practice Address - Fax:480-722-0302
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2008-12-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ5882225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ72241Medicare ID - Type Unspecified