Provider Demographics
NPI:1487909263
Name:BOURDEAU, MATTHEW S (PT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:S
Last Name:BOURDEAU
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2653 CEDAR ELM DR
Mailing Address - Street 2:NRH REHAB NETWORK - #215
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-2905
Mailing Address - Country:US
Mailing Address - Phone:410-708-4763
Mailing Address - Fax:
Practice Address - Street 1:2900 S HANOVER ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21225-1232
Practice Address - Country:US
Practice Address - Phone:301-540-6140
Practice Address - Fax:301-540-5190
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2016-08-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MD24069225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist