Matthew T Basa IV, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT-004721 Issued in KY

Practice address

101 Potters LN
Clarksville, IN 47129-1017

Phone

(812) 948-0808

NPI assigned

Jun 29, 2007

Last updated

Jul 10, 2008By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1183075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1215648000000",
    "number": "1710184056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 POTTERS LN",
            "city": "CLARKSVILLE",
            "state": "IN",
            "postal_code": "471291017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 POTTERS LN",
            "city": "CLARKSVILLE",
            "state": "IN",
            "postal_code": "471291017",
            "telephone_number": "812-948-0808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BASA",
        "first_name": "MATTHEW",
        "middle_name": "T",
        "name_suffix": "IV",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-29",
        "last_updated": "2008-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "KY",
            "license": "PT-004721",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05008415A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Clarksville, IN
• Providers in Clarksville, IN by specialty
• Physical Therapist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.