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General NPI Number Information
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NPI Number | 1790115079
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Entity Type | Individual
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Provider Name | MATTHEW ALLARD
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Gender | Male
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Dates
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Enumeration Date | 11/22/2013
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Last Update Date | 11/22/2013
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Provider Practice Location Address
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Address Line | 700 W PETE ROSE WAY #225
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City | CINCINNATI
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State | OH
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Zip | 45203-1892
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Country | US
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Telephone | 888-752-9640
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Fax |
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Provider Business Mailing Address
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Address Line | 3957 NATIONAL RD
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City | CLAYTON
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State | OH
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Zip | 45315-8798
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Country | US
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Telephone | 937-974-2216
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 08593
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License Number State | OH
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