Healthcare Provider Details

I. General information

NPI: 1427471705
Provider Name (Legal Business Name): MICHELLE MATTHEWS PT, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2014
Last Update Date: 04/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5985 WILCOX PL STE C
DUBLIN OH
43016-6798
US

IV. Provider business mailing address

5054 VININGTON PL
DUBLIN OH
43016-8010
US

V. Phone/Fax

Practice location:
  • Phone: 614-600-9457
  • Fax:
Mailing address:
  • Phone: 614-600-9457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13154
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number33.021475
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number6951
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: