Provider Demographics
NPI:1902869712
Name:STUTZ, MATTHEW REX (ATC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:REX
Last Name:STUTZ
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2080 NE CHANEL CT
Mailing Address - Street 2:APT 4
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-5371
Mailing Address - Country:US
Mailing Address - Phone:540-408-7269
Mailing Address - Fax:540-382-1681
Practice Address - Street 1:2200 NE NEFF RD
Practice Address - Street 2:STE 200
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4283
Practice Address - Country:US
Practice Address - Phone:541-382-3344
Practice Address - Fax:541-382-1681
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORAT-AT-10052492255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer