Individual
MATTHEW RICHARD STAPLETON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
9241 UNIVERSITY BLVD, STE A, NORTH CHARLESTON, SC 29406-9349
(843) 414-1140
(843) 553-2946
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
(630) 296-2223
(630) 759-9510
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
J10002345
DE
225100000X
Physical Therapist
Primary
P14235
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1205096377
CHAMPUS TRICARE
—
05
—
1205096377
—
DE
01
—
3527169000
AMERIHEALTH IBC
—
01
—
5070-0096
GHMSI
MD
01
—
88760501
CAREFIRST
MD
Enumeration date
06/12/2008
Last updated
12/15/2015
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