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General NPI Number Information
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NPI Number | 1184464653
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Entity Type | Individual
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Provider Name | REDDICK RAY MATULAC TERRE PT
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Gender | Male
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Dates
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Enumeration Date | 05/30/2024
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Last Update Date | 01/23/2025
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Provider Practice Location Address
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Address Line | 1275 HIGHWAY 54 W STE 200
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-4538
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Country | US
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Telephone | 770-460-8609
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 CORPORATE DR STE 400
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City | HOOVER
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State | AL
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Zip | 35242-5424
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Country | US
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Telephone | 423-238-7217
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 12114
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT017576
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License Number State | GA
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