Provider Demographics
NPI:1962904755
Name:ZAHL, MATTHEW CONRAD (PT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:CONRAD
Last Name:ZAHL
Suffix:
Gender:M
Credentials:PT
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Mailing Address - Street 1:18000 COVE STREET
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-1383
Mailing Address - Country:US
Mailing Address - Phone:616-847-1280
Mailing Address - Fax:616-847-1290
Practice Address - Street 1:541 E SLOCUM STREET
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:MI
Practice Address - Zip Code:49461-1170
Practice Address - Country:US
Practice Address - Phone:616-847-1280
Practice Address - Fax:616-847-1290
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-07
Last Update Date:2024-12-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5501016624225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist