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General NPI Number Information
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NPI Number | 1043183494
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Entity Type | Individual
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Provider Name | ELIJAH LUKE MATTHEWS PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 09/23/2025
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 25 S TERRY AVE UNIT 310
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City | ORLANDO
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State | FL
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Zip | 32805-1843
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Country | US
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Telephone | 407-641-2446
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Fax |
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Provider Business Mailing Address
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Address Line | 403 SAN LEANDRO DR
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City | CASSELBERRY
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State | FL
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Zip | 32707-5711
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number | 39278
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License Number State | FL
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