Provider Demographics
NPI:1811276454
Name:DEERINGER, MATT (MED, ATC)
Entity type:Individual
Prefix:
First Name:MATT
Middle Name:
Last Name:DEERINGER
Suffix:
Gender:M
Credentials:MED, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10322 CALDWELL DEPOT RD
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-8152
Mailing Address - Country:US
Mailing Address - Phone:704-608-1286
Mailing Address - Fax:866-472-7086
Practice Address - Street 1:10322 CALDWELL DEPOT RD
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-8152
Practice Address - Country:US
Practice Address - Phone:704-608-1286
Practice Address - Fax:866-472-7086
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-14
Last Update Date:2011-08-14
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer