Provider Demographics
NPI:1821721689
Name:CHEA, MATTHEW RAPHAEL
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:RAPHAEL
Last Name:CHEA
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 1:415 SAM DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40214-6008
Mailing Address - Country:US
Mailing Address - Phone:502-759-9876
Mailing Address - Fax:
Practice Address - Street 1:415 SAM DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40214-6008
Practice Address - Country:US
Practice Address - Phone:502-759-9876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-07
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACP018230T225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist