Provider Demographics
NPI:1639165210
Name:MATTINGLY, THOMAS MATTHEW (MSPT)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:MATTHEW
Last Name:MATTINGLY
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
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Mailing Address - Street 1:4636 COMBS FERRY RD STE 1
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-8086
Mailing Address - Country:US
Mailing Address - Phone:859-229-2203
Mailing Address - Fax:859-625-0969
Practice Address - Street 1:237 E HIGHWAY 60
Practice Address - Street 2:
Practice Address - City:HARDINSBURG
Practice Address - State:KY
Practice Address - Zip Code:40143-4892
Practice Address - Country:US
Practice Address - Phone:270-580-4444
Practice Address - Fax:270-257-6252
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY004657225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100401470Medicaid