Provider Demographics
NPI:1023495363
Name:SMITH, MATTHEW PHILIP (MS, ATC)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:PHILIP
Last Name:SMITH
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Gender:M
Credentials:MS, ATC
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Mailing Address - Street 1:1 COLLEGE AND MAIN
Mailing Address - Street 2:CAPITAL ATHLETIC TRAINING
Mailing Address - City:BEXLEY
Mailing Address - State:OH
Mailing Address - Zip Code:43209-7812
Mailing Address - Country:US
Mailing Address - Phone:614-236-6622
Mailing Address - Fax:614-236-6624
Practice Address - Street 1:1 COLLEGE AND MAIN
Practice Address - Street 2:CAPITAL ATHLETIC TRAINING
Practice Address - City:BEXLEY
Practice Address - State:OH
Practice Address - Zip Code:43209-7812
Practice Address - Country:US
Practice Address - Phone:614-236-6622
Practice Address - Fax:614-236-6624
Is Sole Proprietor?:No
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH45002255A2300X
SC11332255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer