Provider Demographics
NPI:1346431749
Name:MATTHEWS, MARTHA E (CPO)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:E
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 MEDICAL PARK RD STE 102
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8529
Mailing Address - Country:US
Mailing Address - Phone:704-765-9837
Mailing Address - Fax:704-997-2679
Practice Address - Street 1:146 MEDICAL PARK RD STE 102
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8529
Practice Address - Country:US
Practice Address - Phone:704-765-9837
Practice Address - Fax:704-997-2679
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795165Medicaid