Provider Demographics
NPI:1457622169
Name:RANKIN, MATTHEW JON (ATC)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:JON
Last Name:RANKIN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-3470
Mailing Address - Country:US
Mailing Address - Phone:419-304-0485
Mailing Address - Fax:
Practice Address - Street 1:2100 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-3470
Practice Address - Country:US
Practice Address - Phone:419-304-0485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-26
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT10322255A2300X
MI26010004222255A2300X
FLAL.29682255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer