Provider Demographics
NPI:1457508202
Name:THOMAS, MATTHEW ROBERT (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ROBERT
Last Name:THOMAS
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 GLEN RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6012
Mailing Address - Country:US
Mailing Address - Phone:603-785-0220
Mailing Address - Fax:
Practice Address - Street 1:1900 S UNIVERSITY PARKS DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76706-1654
Practice Address - Country:US
Practice Address - Phone:603-785-0220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-23
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer