Provider Demographics
NPI:1255461950
Name:KNOWLES, MATTHEW CHARLES (MAED, ATC, LAT)
Entity type:Individual
Prefix:MRS
First Name:MATTHEW
Middle Name:CHARLES
Last Name:KNOWLES
Suffix:
Gender:M
Credentials:MAED, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 LAKESHORE RDG
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35211-6954
Mailing Address - Country:US
Mailing Address - Phone:850-572-7161
Mailing Address - Fax:
Practice Address - Street 1:SAMFORD UNIVERSITY 800 LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35229-0001
Practice Address - Country:US
Practice Address - Phone:205-726-4311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7252255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer