Matthew Marciano, DPT, PT, CSCS
Individual provider Active NPI Physical Therapist · Bluffdale, UT
NPI 1699446302 · NPPES record last updated Sep 22, 2021
Key facts
- NPI
- 1699446302
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 11793400-2401 (UT)
- Practice address
- 974 W 14420 S Ste 5
Bluffdale, UT 84065-1630 - Phone
- (773) 425-2772
- NPI assigned
- Sep 22, 2021
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11793400-2401 | UT | MD | Orthopedic Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Physical Therapist | 2251S0007X | 11793400-2401 | UT | |
| Orthopedic Physical Therapist | 2251X0800X | 11793400-2401 | UT | |
| Physical Therapist | 225100000X | 11793400-2401 | UT | Yes |
Addresses
Primary practice location
974 W 14420 S Ste 5
Bluffdale, UT 84065-1630
Mailing address
5388 W Orion Hills CV
West Jordan, UT 84081-3971
Phone (773) 425-2772
Other providers in Bluffdale, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 22, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.