Provider Demographics
NPI:1114276508
Name:MURPHY, MATTHEW S (PT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:S
Last Name:MURPHY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 E INDIANA STREET
Mailing Address - Street 2:SUITE 102
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715
Mailing Address - Country:US
Mailing Address - Phone:812-476-0409
Mailing Address - Fax:812-476-1016
Practice Address - Street 1:225 CROSSLAKE DR
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-8198
Practice Address - Country:US
Practice Address - Phone:812-477-1558
Practice Address - Fax:812-474-2296
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY006077225100000X
IN05010966A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201134470Medicaid
IN000000794920OtherBLUE CROSS BLUE SHIELD
IN000000794929OtherBLUE CROSS BLUE SHIELD
IN000000795110OtherBLUE CROSS BLUE SHIELD
KY000000808332OtherBLUE CROSS BLUE SHIELD
IN201134470Medicaid
IN216070007Medicare PIN
KYK079910Medicare PIN
IN198850010Medicare PIN
IN000000794920OtherBLUE CROSS BLUE SHIELD