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General NPI Number Information
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NPI Number | 1336676352
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Entity Type | Individual
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Provider Name | MATTHEW MICHAEL HANKS M.ED., ATC, LAT
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Gender | Male
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Dates
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Enumeration Date | 05/22/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1228 HALEY CTR
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City | AUBURN
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State | AL
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Zip | 36849-0001
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Country | US
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Telephone | 334-844-2096
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Fax |
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Provider Business Mailing Address
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Address Line | 626 SHUG JORDAN PKWY APT 235
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City | AUBURN
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State | AL
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Zip | 36832-4339
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Country | US
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Telephone | 616-644-3592
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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 | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 1676
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License Number State | AL
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