Provider Demographics
NPI:1437861507
Name:MATTHEWS, DARRELL JACOB (PTA)
Entity Type:Individual
Prefix:MR
First Name:DARRELL
Middle Name:JACOB
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 EAST WEST PKWY
Mailing Address - Street 2:SUITE 11&12
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003
Mailing Address - Country:US
Mailing Address - Phone:904-215-3958
Mailing Address - Fax:904-215-3970
Practice Address - Street 1:1835 EAST WEST PKWY
Practice Address - Street 2:SUITE 11&12
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003
Practice Address - Country:US
Practice Address - Phone:904-215-3958
Practice Address - Fax:904-215-3970
Is Sole Proprietor?:No
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist