Provider Demographics
NPI:1275806820
Name:SMITH, MATTHEW ALAN (MSPT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ALAN
Last Name:SMITH
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 CORBIN CENTER DR
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-1895
Mailing Address - Country:US
Mailing Address - Phone:606-526-2934
Mailing Address - Fax:606-526-2901
Practice Address - Street 1:202 KIDD DR
Practice Address - Street 2:SUITE 3
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-7000
Practice Address - Country:US
Practice Address - Phone:859-228-0201
Practice Address - Fax:859-228-0206
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPT004993225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist