Provider Demographics
NPI:1194797522
Name:MOLTER, MATTHEW JOSEPH (MPT)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:JOSEPH
Last Name:MOLTER
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 EDINBURGH WAY
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-9007
Mailing Address - Country:US
Mailing Address - Phone:530-221-9060
Mailing Address - Fax:
Practice Address - Street 1:1740 MISTLETOE LN
Practice Address - Street 2:STE. A
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-0454
Practice Address - Country:US
Practice Address - Phone:530-222-2083
Practice Address - Fax:530-222-8258
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT21242225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist