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General NPI Number Information
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NPI Number | 1992926422
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Entity Type | Individual
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Provider Name | MATTHEW CONYERS PA, ATC
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Gender | Male
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 04/12/2023
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Provider Practice Location Address
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Address Line | 5798 38TH AVE N
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City | ST PETERSBURG
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State | FL
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Zip | 33710-1926
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Country | US
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Telephone | 727-384-0192
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Fax | 727-384-1500
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Provider Business Mailing Address
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Address Line | 5400 PINEHURST DR
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City | SPRING HILL
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State | FL
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Zip | 34606-3833
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Country | US
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Telephone | 352-277-5305
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Fax | 352-616-0926
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9110494
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License Number State | FL
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