Matthew Fackner, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

Practice address

55 N York Rd
Hatboro, PA 19040-3149

Phone

(215) 394-5116

NPI assigned

Feb 7, 2018

Last updated

Mar 17, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Willow Grove Physical Therapy LLCGroup PAC ID 0749189256, 22 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Willow Grove Physical Therapy, LLC

  • Physical Therapy Clinic/Center
  • Willow Grove, PA
  • NPI 1083659783

  Physical Therapist

  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1517961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1457850224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 MERCER AVE",
            "city": "DOYLESTOWN",
            "state": "PA",
            "postal_code": "189013927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 N YORK RD",
            "city": "HATBORO",
            "state": "PA",
            "postal_code": "190403149",
            "telephone_number": "215-394-5116"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1003 Easton Rd",
            "address_purpose": "LOCATION",
            "city": "Willow Grove",
            "state": "PA",
            "postal_code": "190902027",
            "country_code": "US",
            "telephone_number": "215-659-7759",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FACKNER",
        "first_name": "MATTHEW",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-02-07",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas Joseph Dwyer, MA, LPC
• Mary Josephine Eidson, LCSW, CCDP
• Enadia Elvidge
• Equitable Parenting Lab (Arts in Counseling)
• Mojgan Evoghlian, PHARM. D.
• Vanessa Fajotina, LSW
• Meaghan Fattizzi, LCSW
• Jamie Fechnay, MSOT, OTR/L
• George Filip, MS, LPC
• Lewis P Fleishman, O.D.

• Physical Therapist in Hatboro, PA
• Providers in Hatboro, PA by specialty
• Physical Therapist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.