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General NPI Number Information
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NPI Number | 1568152965
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Entity Type | Individual
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Provider Name | MATTHEW J. TACK DPT
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Gender | Male
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Dates
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Enumeration Date | 05/09/2023
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 340 POLARIS PKWY
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City | WESTERVILLE
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State | OH
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Zip | 43082-7971
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Country | US
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Telephone | 614-839-2300
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Fax | 614-839-2301
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Provider Business Mailing Address
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Address Line | 340 POLARIS PKWY
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City | WESTERVILLE
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State | OH
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Zip | 43082-7971
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Country | US
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Telephone | 614-545-7900
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Fax | 614-545-7901
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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 | PT020413
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License Number State | OH
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