Provider Demographics
NPI:1699556720
Name:WEST, MATTHEW WEST THOMAS
Entity type:Individual
Prefix:
First Name:MATTHEW WEST
Middle Name:THOMAS
Last Name:WEST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 HAWKEYE CT UNIT A1-105
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52246-2850
Mailing Address - Country:US
Mailing Address - Phone:515-419-6888
Mailing Address - Fax:
Practice Address - Street 1:102 HAWKEYE CT UNIT A1-105
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52246-2850
Practice Address - Country:US
Practice Address - Phone:515-419-6888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer