Provider Demographics
NPI:1639054893
Name:OSBORN, MATTHEW PETER HERMAN (DPT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:PETER HERMAN
Last Name:OSBORN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11225 ARDENCROFT DR S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-0568
Mailing Address - Country:US
Mailing Address - Phone:352-697-0533
Mailing Address - Fax:
Practice Address - Street 1:630 E TWINCOURT TRL STE 110
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32095-9113
Practice Address - Country:US
Practice Address - Phone:203-464-9761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-07
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT43477225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist