Provider Demographics
NPI:1952753618
Name:BARNES, MATTHEW KYLE (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:KYLE
Last Name:BARNES
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W RAINBOW RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-3023
Mailing Address - Country:US
Mailing Address - Phone:281-825-9894
Mailing Address - Fax:
Practice Address - Street 1:100 W RAINBOW RIDGE CIR
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-3023
Practice Address - Country:US
Practice Address - Phone:281-825-9894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20000256442255A2300X
TXAT58722255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer