Provider Demographics
NPI:1427156918
Name:MATSON, DENISE GAIL (PT)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:GAIL
Last Name:MATSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:GAIL
Other - Last Name:TURNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 1086
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44096-1086
Mailing Address - Country:US
Mailing Address - Phone:216-645-7242
Mailing Address - Fax:
Practice Address - Street 1:2291 WEST FOURTH STREET
Practice Address - Street 2:SUITE D
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-1261
Practice Address - Country:US
Practice Address - Phone:419-589-2238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT06506225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000356114OtherANTHEM