Provider Demographics
NPI:1053476101
Name:MATTHEWS PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:MATTHEWS PHYSICAL THERAPY INC
Other - Org Name:CLINTON PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:RENA
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-745-8881
Mailing Address - Street 1:2000 HWY 25B NORTH
Mailing Address - Street 2:SUITE A1
Mailing Address - City:HEBER SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72543
Mailing Address - Country:US
Mailing Address - Phone:501-362-7195
Mailing Address - Fax:501-362-7855
Practice Address - Street 1:230 HIGHWAY 65 N STE 6
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:AR
Practice Address - Zip Code:72031-6676
Practice Address - Country:US
Practice Address - Phone:501-745-8881
Practice Address - Fax:501-745-3113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT1319225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR139712742Medicaid