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NPI Code Detail

MEDICARE: MR. MATTHEW WADE THORNTON MSPT

MEDICARE: MR. MATTHEW WADE THORNTON MSPT
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
12251S0007XSports Physical TherapistPT2194AR
22251X0800XOrthopedic Physical TherapistPT2194AR
3225100000XPhysical TherapistPT2194AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1457316572
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MATTHEW WADE THORNTON MSPT
Provider Business Mailing Address
First Line : 5220 NORRTHSHORE DR
Second Line :
City : NORTH LITTLE ROCK
State : AR
Zip : 72118-5297
Country : US
Telephone Number : 501-663-4320
Fax Number : 501-978-1452
Provider Business Practice Location Address
First Line : 5220 NORTHSHORE DR
Second Line :
City : NORTH LITTLE ROCK
State : AR
Zip : 72118-5297
Country : US
Telephone Number : 501-663-4320
Fax Number : 501-978-1452
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2006
Last Update Date : 04/01/2025

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