MEDICARE: MATTHEW ELLER DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	P22183	NC

General Provider Information

NPI Number	:	1326738337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW ELLER DPT

Provider Business Mailing Address
First Line	:	1200 CORPORATE DR STE 400
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35242-5424
Country	:	US
Telephone Number	:	423-541-5492
Fax Number	:

Provider Business Practice Location Address
First Line	:	16615 W CATAWBA AVE STE D
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-8989
Country	:	US
Telephone Number	:	704-987-4322
Fax Number	:	704-987-7959

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2023
Last Update Date	:	05/11/2023

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Directions to “ MATTHEW ELLER DPT” Practice Location

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