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General NPI Number Information
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NPI Number | 1720987647
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Entity Type | Individual
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Provider Name | MATTHEW DOYLE TYSON DPT
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Gender | Male
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Dates
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Enumeration Date | 11/05/2026
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Last Update Date | 11/05/2026
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Provider Practice Location Address
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Address Line | 530 E OLYMPIA AVE STE 112
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City | PUNTA GORDA
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State | FL
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Zip | 33950-3838
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Country | US
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Telephone | 941-575-7300
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Fax | 941-505-7301
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Provider Business Mailing Address
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Address Line | 1650 LYNDON FARM CT STE 300
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City | LOUISVILLE
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State | KY
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Zip | 40223-5005
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT45649
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License Number State | FL
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