# MATTHEW STEVEN BLIEVERNICHT

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1760640213
- **Gender:** Man
- **Credential:** PT

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 11016 | WI | Yes |
| 225100000X | Physical Therapist | 5973 | OR | — |

## Other

- **Enumeration date:** 05/30/2008
- **Last updated:** 01/07/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0252231 | WASHINGTON L&I | OR |
| 05 | — | 100257659 | — | WI |
| 05 | — | 100298600 | — | WI |
| 05 | — | 500609437 | — | OR |
| 01 | — | P00802449 | RR MEDICARE | OR |