Provider Demographics
NPI:1790115079
Name:ALLARD, MATTHEW
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:ALLARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3957 NATIONAL RD
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45315-8798
Mailing Address - Country:US
Mailing Address - Phone:937-974-2216
Mailing Address - Fax:
Practice Address - Street 1:700 W PETE ROSE WAY
Practice Address - Street 2:#225
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45203-1892
Practice Address - Country:US
Practice Address - Phone:888-752-9640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-22
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH08593225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant