Provider Demographics
NPI:1730474867
Name:LAMBETH, MATTHEW S (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:S
Last Name:LAMBETH
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 1:1121 S MAGNOLIA ST STE 800
Mailing Address - Street 2:
Mailing Address - City:WOODVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75979-5672
Mailing Address - Country:US
Mailing Address - Phone:409-200-2804
Mailing Address - Fax:
Practice Address - Street 1:1121 S MAGNOLIA ST STE 800
Practice Address - Street 2:
Practice Address - City:WOODVILLE
Practice Address - State:TX
Practice Address - Zip Code:75979-5672
Practice Address - Country:US
Practice Address - Phone:409-200-2804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1206232225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist