Healthcare Provider Details

I. General information

NPI: 1922599075
Provider Name (Legal Business Name): MATTHEW REICHARD DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2018
Last Update Date: 05/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4532 W GATE BLVD STE 100
AUSTIN TX
78745-1410
US

IV. Provider business mailing address

12508 JONES MALTSBERGER RD STE 110
SAN ANTONIO TX
78247-4215
US

V. Phone/Fax

Practice location:
  • Phone: 512-892-7337
  • Fax:
Mailing address:
  • Phone: 888-590-4002
  • Fax: 210-590-4585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1304880
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: