Provider Demographics
NPI:1316270473
Name:GAUNT, MATTHEW THOMAS (DPT)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:THOMAS
Last Name:GAUNT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
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Mailing Address - Street 1:2810 CHARLEVOIX RD STE 105
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-8421
Mailing Address - Country:US
Mailing Address - Phone:231-881-9770
Mailing Address - Fax:231-881-9780
Practice Address - Street 1:2810 CHARLEVOIX RD
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-8421
Practice Address - Country:US
Practice Address - Phone:231-881-9770
Practice Address - Fax:231-881-9780
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010135022251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI23-6707Medicare PIN