Provider Demographics
NPI:1558531061
Name:MATTHEWS PHYSICAL THERAPY
Entity Type:Organization
Organization Name:MATTHEWS PHYSICAL THERAPY
Other - Org Name:CLINTON PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:B
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-745-8881
Mailing Address - Street 1:119 INGRAM ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:CLINTON
Mailing Address - State:AR
Mailing Address - Zip Code:72031-6889
Mailing Address - Country:US
Mailing Address - Phone:501-745-8881
Mailing Address - Fax:501-745-3113
Practice Address - Street 1:119 INGRAM ST
Practice Address - Street 2:SUITE B
Practice Address - City:CLINTON
Practice Address - State:AR
Practice Address - Zip Code:72031-6889
Practice Address - Country:US
Practice Address - Phone:501-745-8881
Practice Address - Fax:501-745-3113
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MATTHEWS PHYSICAL THERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-11
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5F194Medicare PIN