Provider Demographics
NPI:1619177904
Name:HARDIN, MATTHEW (PTA)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:HARDIN
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 1:109 GOINGS RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HARDY
Mailing Address - State:AR
Mailing Address - Zip Code:72542-8810
Mailing Address - Country:US
Mailing Address - Phone:870-239-1032
Mailing Address - Fax:
Practice Address - Street 1:109 GOINGS RIDGE RD
Practice Address - Street 2:
Practice Address - City:HARDY
Practice Address - State:AR
Practice Address - Zip Code:72542-8810
Practice Address - Country:US
Practice Address - Phone:870-239-1032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2014-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1349225200000X
MO2006012978225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR142525721Medicaid