Provider Demographics
NPI:1508969080
Name:MATTHEWS PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:MATTHEWS PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:ZITO
Authorized Official - Suffix:
Authorized Official - Credentials:LPT
Authorized Official - Phone:704-847-6351
Mailing Address - Street 1:1352 MATTHEWS TOWNSHIP PARKWAY
Mailing Address - Street 2:UNIT 102
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105
Mailing Address - Country:US
Mailing Address - Phone:704-847-6351
Mailing Address - Fax:704-849-2826
Practice Address - Street 1:1352 MATTHEWS TOWNSHIP PARKWAY
Practice Address - Street 2:UNIT 102
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105
Practice Address - Country:US
Practice Address - Phone:704-847-6351
Practice Address - Fax:704-849-2826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7207922Medicaid
NC0213VOtherBCBS OF NC
NC2136238OtherAETNA
NC2136238OtherAETNA