Healthcare Provider Details

I. General information

NPI: 1457052649
Provider Name (Legal Business Name): MATTHEW GIRARD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

394 HARDING PL STE 200
NASHVILLE TN
37211-3980
US

IV. Provider business mailing address

PO BOX 370
FORTSON GA
31808-0370
US

V. Phone/Fax

Practice location:
  • Phone: 615-834-4708
  • Fax:
Mailing address:
  • Phone: 706-494-3072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14747
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: