Provider Demographics
NPI:1942780580
Name:STIMSON, MATTHEW D (CPED, CPOA, CFO)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:D
Last Name:STIMSON
Suffix:
Gender:M
Credentials:CPED, CPOA, CFO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 CLAIRE STEVENS CIR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37931-4552
Mailing Address - Country:US
Mailing Address - Phone:865-256-6288
Mailing Address - Fax:
Practice Address - Street 1:2435 JACKSBORO PIKE STE 3
Practice Address - Street 2:
Practice Address - City:LA FOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766-2912
Practice Address - Country:US
Practice Address - Phone:423-449-8135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNCFO03775225000000X
TNPED109224L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter