Provider Demographics
NPI:1003113366
Name:MURRAY, MATTHEW TIMOTHY (DPT)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:TIMOTHY
Last Name:MURRAY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 GATEWAY BUSINESS PARK DR
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-7395
Mailing Address - Country:US
Mailing Address - Phone:706-937-5771
Mailing Address - Fax:
Practice Address - Street 1:97 GATEWAY BUSINESS PARK DR
Practice Address - Street 2:
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736-7395
Practice Address - Country:US
Practice Address - Phone:706-937-5771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-23
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA010204174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP01021072Medicare PIN