| Doctor Name: | MR. MATTHEW RYAN NICKERSON |
| NPI Number: | 1164827044 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | P.T. DPT |
| License Number: | 10936 |
| Business Practice Address: | 725 S. Dobson Rd Suite 203 Chandler, AZ - 852245679 |
| Business Phone Number: | 4808076500 |
| Business Fax Number: | 4808972700 |
| Mailing Address: | 4858 E Baseline Rd, Suite 107 MESA |
| State: | AZ |
| Postal Code: | 852064638 |
| Phone Number: | 4808076500 |
| Fax Number: | 4808972700 |
| NPI Enumeration Date: | 11/04/2014 |
| NPI Last Update Date: | 11/04/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 10936 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |