Provider Demographics
NPI:1194895706
Name:MILLET, MATTHEW JAMES (PT, DPT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JAMES
Last Name:MILLET
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 N RITA LN
Mailing Address - Street 2:#117
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-6073
Mailing Address - Country:US
Mailing Address - Phone:480-656-5581
Mailing Address - Fax:
Practice Address - Street 1:1331 N 7TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2754
Practice Address - Country:US
Practice Address - Phone:602-271-4516
Practice Address - Fax:602-271-9909
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ72962251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic