Provider Demographics
NPI:1457316572
Name:THORNTON, MATTHEW WADE (MSPT)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:WADE
Last Name:THORNTON
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5220 NORRTHSHORE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72118-5297
Mailing Address - Country:US
Mailing Address - Phone:501-663-4320
Mailing Address - Fax:501-978-1452
Practice Address - Street 1:5220 NORTHSHORE DR
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72118-5297
Practice Address - Country:US
Practice Address - Phone:501-663-4320
Practice Address - Fax:501-978-1452
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT21942251S0007X, 225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR152427721Medicaid
5W677Medicare ID - Type Unspecified