Healthcare Provider Details

I. General information

NPI: 1871815373
Provider Name (Legal Business Name): MATTHEW CULP ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2010
Last Update Date: 08/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 HOPE ST BROWN UNIVERSITY - BOX 1933
PROVIDENCE RI
02912-9090
US

IV. Provider business mailing address

616 HOPE ST
PROVIDENCE RI
02906-2659
US

V. Phone/Fax

Practice location:
  • Phone: 401-863-3851
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT00216
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: