Provider Demographics
NPI:1295402444
Name:LIM, MATHEW TRAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MATHEW
Middle Name:TRAN
Last Name:LIM
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 1:100 WALMART DR STE 5
Mailing Address - Street 2:
Mailing Address - City:MORRILTON
Mailing Address - State:AR
Mailing Address - Zip Code:72110-4525
Mailing Address - Country:US
Mailing Address - Phone:501-477-2202
Mailing Address - Fax:501-421-0543
Practice Address - Street 1:100 WALMART DR STE 5
Practice Address - Street 2:
Practice Address - City:MORRILTON
Practice Address - State:AR
Practice Address - Zip Code:72110-4525
Practice Address - Country:US
Practice Address - Phone:501-477-2202
Practice Address - Fax:501-421-0543
Is Sole Proprietor?:No
Enumeration Date:2021-08-25
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR5034225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist