Healthcare Provider Details

I. General information

NPI: 1639165210
Provider Name (Legal Business Name): THOMAS MATTHEW MATTINGLY MSPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 E HIGHWAY 60
HARDINSBURG KY
40143-4892
US

IV. Provider business mailing address

4636 COMBS FERRY RD STE 1
WINCHESTER KY
40391-8086
US

V. Phone/Fax

Practice location:
  • Phone: 270-580-4444
  • Fax: 270-257-6252
Mailing address:
  • Phone: 859-229-2203
  • Fax: 859-625-0969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number004657
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: