Provider Demographics
NPI:1578005716
Name:WILLIAMS, MATTHEW BRENT (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:BRENT
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 S 3RD ST STE B
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-2090
Mailing Address - Country:US
Mailing Address - Phone:859-236-7012
Mailing Address - Fax:
Practice Address - Street 1:321 S 3RD ST STE B
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-2090
Practice Address - Country:US
Practice Address - Phone:859-236-7012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY007019225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist