Provider Demographics
NPI:1457977498
Name:MATTHEWS-ELLINGER, WINDY (PT)
Entity type:Individual
Prefix:
First Name:WINDY
Middle Name:
Last Name:MATTHEWS-ELLINGER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1719 HEYWARD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-3211
Mailing Address - Country:US
Mailing Address - Phone:803-513-5456
Mailing Address - Fax:855-232-8604
Practice Address - Street 1:1719 HEYWARD ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-3211
Practice Address - Country:US
Practice Address - Phone:803-513-5456
Practice Address - Fax:855-232-8604
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1323225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist