Provider Demographics
NPI:1174857965
Name:MCEWEN, MATTHEW (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:MCEWEN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5006 ATWOOD DR
Mailing Address - Street 2:#2
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-8179
Mailing Address - Country:US
Mailing Address - Phone:859-623-2057
Mailing Address - Fax:
Practice Address - Street 1:5006 ATWOOD DR
Practice Address - Street 2:#2
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-8179
Practice Address - Country:US
Practice Address - Phone:859-623-2057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-25
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY005499225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist