Provider Demographics
NPI:1407240781
Name:DOWNHAM, MATTHEW LEE (ATS)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:LEE
Last Name:DOWNHAM
Suffix:
Gender:M
Credentials:ATS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7745 N 400 E
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:IN
Mailing Address - Zip Code:46917-9146
Mailing Address - Country:US
Mailing Address - Phone:765-202-4044
Mailing Address - Fax:
Practice Address - Street 1:7745 N 400 E
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:IN
Practice Address - Zip Code:46917-9146
Practice Address - Country:US
Practice Address - Phone:765-202-4044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-24
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer