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NPI Code Detail

MEDICARE: MR. MATTHEW DAVIS DPT

MEDICARE: MR. MATTHEW DAVIS 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
12251X0800XOrthopedic Physical Therapist7669SC
2225100000XPhysical TherapistP20242NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10397730029OTHERNCNSC #

General Provider Information

NPI Number : 1568856029
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MATTHEW DAVIS DPT
Provider Business Mailing Address
First Line : PO BOX 601791
Second Line :
City : CHARLOTTE
State : NC
Zip : 28260-1791
Country : US
Telephone Number : 704-323-2500
Fax Number :
Provider Business Practice Location Address
First Line : 5935 CARNEGIE BLVD STE 104
Second Line :
City : CHARLOTTE
State : NC
Zip : 28209-4672
Country : US
Telephone Number : 704-323-2500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2015
Last Update Date : 01/15/2025

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