MEDICARE: MATTHEW GRAYSON MEDLIN DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	14414	NC

General Provider Information

NPI Number	:	1467889139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW GRAYSON MEDLIN DPT

Provider Business Mailing Address
First Line	:	800 CRESCENT CENTRE DR STE 600
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-7286
Country	:	US
Telephone Number	:	615-373-1350
Fax Number	:	615-221-9054

Provider Business Practice Location Address
First Line	:	112 GRAND HILL PL
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-4416
Country	:	US
Telephone Number	:	919-346-5815
Fax Number	:	919-346-5816

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2013
Last Update Date	:	12/28/2017

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