Healthcare Provider Details

I. General information

NPI: 1760668800
Provider Name (Legal Business Name): LISA MERRYMAN MATCHETT MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2008
Last Update Date: 01/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CENTURY PARK S SUITE 128
BIRMINGHAM AL
35226-3943
US

IV. Provider business mailing address

700 CENTURY PARK S SUITE 128
BIRMINGHAM AL
35226-3943
US

V. Phone/Fax

Practice location:
  • Phone: 205-823-1215
  • Fax: 205-822-4999
Mailing address:
  • Phone: 205-823-1215
  • Fax: 205-822-4999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPTH3251
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: