Provider Demographics
NPI:1568960870
Name:MCDOUGAL, MATTHEW W (PT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:W
Last Name:MCDOUGAL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HORIZON DR STE 115
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-4947
Mailing Address - Country:US
Mailing Address - Phone:919-875-1932
Mailing Address - Fax:919-875-1933
Practice Address - Street 1:200 HORIZON DR STE 115
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-4947
Practice Address - Country:US
Practice Address - Phone:919-875-1932
Practice Address - Fax:919-875-1933
Is Sole Proprietor?:No
Enumeration Date:2018-02-01
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP17688225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
14204887OtherCAQH