Provider Demographics
NPI:1174867998
Name:WAY, MATTHEW BLAIR (LAT,ATC)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:BLAIR
Last Name:WAY
Suffix:
Gender:M
Credentials:LAT,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3700 CLINTON PKWY
Mailing Address - Street 2:APARTMENT 1505
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047-2199
Mailing Address - Country:US
Mailing Address - Phone:316-305-2444
Mailing Address - Fax:
Practice Address - Street 1:10730 NALL AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1366
Practice Address - Country:US
Practice Address - Phone:913-945-9829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24-004962255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer