Healthcare Provider Details

I. General information

NPI: 1225766488
Provider Name (Legal Business Name): MATTHEW CHARLES FLEMING PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4027 I 49 S SERVICE RD
OPELOUSAS LA
70570-0757
US

IV. Provider business mailing address

4324 S SHERWOOD FOREST BLVD STE B170
BATON ROUGE LA
70816-4481
US

V. Phone/Fax

Practice location:
  • Phone: 337-948-4212
  • Fax: 337-942-9979
Mailing address:
  • Phone: 225-654-8208
  • Fax: 225-465-8823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11344
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: