Healthcare Provider Details

I. General information

NPI: 1750354031
Provider Name (Legal Business Name): MATTHEW RICHARD DOYLE MS, LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 03/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 PRAIRIE MEADOW DR
IOWA CITY IA
52242-8001
US

IV. Provider business mailing address

3020 HIGH BLUFF CT
CORALVILLE IA
52241-9731
US

V. Phone/Fax

Practice location:
  • Phone: 319-467-8255
  • Fax:
Mailing address:
  • Phone: 319-626-8804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number00211
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: