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General NPI Number Information
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NPI Number | 1730546292
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Entity Type | Individual
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Provider Name | MATTHEW MATTOX P.T.
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Gender | Male
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Dates
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Enumeration Date | 01/28/2016
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Last Update Date | 01/28/2016
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Provider Practice Location Address
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Address Line | 560 HIGHWAY 98 BYP
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City | COLUMBIA
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State | MS
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Zip | 39429-3538
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Country | US
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Telephone | 601-444-9200
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Fax |
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Provider Business Mailing Address
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Address Line | 239 OLD HIGHWAY 24
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City | FOXWORTH
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State | MS
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Zip | 39483-4840
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Country | US
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Telephone | 601-441-9942
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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 | PT2003
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License Number State | MS
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