Provider Demographics
NPI:1326025552
Name:LYDEN, MATHEW JON (ATC)
Entity Type:Individual
Prefix:MR
First Name:MATHEW
Middle Name:JON
Last Name:LYDEN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7301 SUTTON PL
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:TN
Mailing Address - Zip Code:37062-9353
Mailing Address - Country:US
Mailing Address - Phone:615-799-7822
Mailing Address - Fax:615-284-4811
Practice Address - Street 1:2000 CHURCH ST
Practice Address - Street 2:BOX 18
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37236-0001
Practice Address - Country:US
Practice Address - Phone:615-284-4808
Practice Address - Fax:615-284-4811
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000004722255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer