Healthcare Provider Details

I. General information

NPI: 1043183494
Provider Name (Legal Business Name): ELIJAH LUKE MATTHEWS PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2025
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 S TERRY AVE UNIT 310
ORLANDO FL
32805-1843
US

IV. Provider business mailing address

403 SAN LEANDRO DR
CASSELBERRY FL
32707-5711
US

V. Phone/Fax

Practice location:
  • Phone: 407-641-2446
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number39278
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: