Basic Information
Provider Information
NPI: 1003806936
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TOTH
FirstName: MATTHEW
MiddleName: J
NamePrefix: MR.
NameSuffix:  
Credential: ATC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3950 SOMERSET DR NE
Address2:  
City: ALBANY
State: OR
PostalCode: 973224519
CountryCode: US
TelephoneNumber: 5417914923
FaxNumber:  
Practice Location
Address1: 3950 SOMERSET DR NE
Address2:  
City: ALBANY
State: OR
PostalCode: 973224519
CountryCode: US
TelephoneNumber: 5417914923
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/22/2005
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2255A2300XAT-AT-1002231ORY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer

No ID Information.


Home