Provider Demographics
NPI:1043473523
Name:DUCKWORTH, MATTHEW STEVEN
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:STEVEN
Last Name:DUCKWORTH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 PARKER ST
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:KY
Mailing Address - Zip Code:40823-1733
Mailing Address - Country:US
Mailing Address - Phone:606-589-6266
Mailing Address - Fax:
Practice Address - Street 1:19101 N US HIGHWAY 119
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:KY
Practice Address - Zip Code:40823-8107
Practice Address - Country:US
Practice Address - Phone:606-589-5421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-06
Last Update Date:2008-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA01875225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant