Healthcare Provider Details

I. General information

NPI: 1346122629
Provider Name (Legal Business Name): MATT ALLEN HUTCHINSON
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2025
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1390 N POPLAR FORK RD
HURRICANE WV
25526-7112
US

IV. Provider business mailing address

108 COLUMBUS ST
SOUTH POINT OH
45680-9344
US

V. Phone/Fax

Practice location:
  • Phone: 304-757-7826
  • Fax:
Mailing address:
  • Phone: 304-634-5165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number001256
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: