Provider Demographics
NPI:1417591686
Name:TAYLOR, MATTHEW (DPT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4216 MACCORKLE AVE SE
Mailing Address - Street 2:STE 4
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-2539
Mailing Address - Country:US
Mailing Address - Phone:304-914-1394
Mailing Address - Fax:
Practice Address - Street 1:4216 MACCORKLE AVE SE STE 4
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-2539
Practice Address - Country:US
Practice Address - Phone:304-926-0913
Practice Address - Fax:304-926-0914
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-31
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty