Provider Demographics
NPI:1447336805
Name:SMITH, MATTHEW RYAN (PT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:RYAN
Last Name:SMITH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2640 DORSET ST
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130
Mailing Address - Country:US
Mailing Address - Phone:615-904-1810
Mailing Address - Fax:931-506-5065
Practice Address - Street 1:203 OAK PARK
Practice Address - Street 2:NHC OAK PARK
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110
Practice Address - Country:US
Practice Address - Phone:931-473-6039
Practice Address - Fax:931-506-5065
Is Sole Proprietor?:No
Enumeration Date:2006-10-28
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN4964225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist