Provider Demographics
NPI:1871573436
Name:MCPHERSON, MATTHEW (PT)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:MCPHERSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4761 LAKE MICHIGAN DR NW
Mailing Address - Street 2:SUITE A
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49534
Mailing Address - Country:US
Mailing Address - Phone:616-392-3197
Mailing Address - Fax:616-392-7959
Practice Address - Street 1:4761 LAKE MICHIGAN DR NW
Practice Address - Street 2:SUITE A
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49534
Practice Address - Country:US
Practice Address - Phone:616-791-7025
Practice Address - Fax:269-686-4264
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7057225100000X
MI5501011054225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ981391Medicaid