Provider Demographics
NPI:1053151977
Name:YANSICK, MATTHEW NEIL (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:NEIL
Last Name:YANSICK
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 W GRANADA AVE
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-1537
Mailing Address - Country:US
Mailing Address - Phone:856-952-1545
Mailing Address - Fax:
Practice Address - Street 1:4515 VALLEY RD STE B
Practice Address - Street 2:
Practice Address - City:ENOLA
Practice Address - State:PA
Practice Address - Zip Code:17025-1401
Practice Address - Country:US
Practice Address - Phone:717-732-8131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT032300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist