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General NPI Number Information
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NPI Number | 1720973092
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Entity Type | Individual
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Provider Name | MATTHEW RANDALL DAMPF PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 06/09/2025
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 2701 W EDGEWOOD DR STE 105
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City | JEFFERSON CITY
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State | MO
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Zip | 65109-5890
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Country | US
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Telephone | 573-761-5130
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Fax |
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Provider Business Mailing Address
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Address Line | 4112 GREENBRIER DR
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City | JEFFERSON CITY
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State | MO
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Zip | 65109-8718
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Country | US
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Telephone | 573-690-6136
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 2025020894
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License Number State | MO
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