Provider Demographics
NPI:1194754267
Name:LUNDIN, MATTHEW TOMAS (ATC)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:TOMAS
Last Name:LUNDIN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N8027 ELSER DR
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-9702
Mailing Address - Country:US
Mailing Address - Phone:937-654-7680
Mailing Address - Fax:
Practice Address - Street 1:N8027 ELSER DR
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-9702
Practice Address - Country:US
Practice Address - Phone:937-654-7680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2226-392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer