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NPI Code Detail

MEDICARE: MATTHEW CHILDRESS DPT

MEDICARE: MATTHEW CHILDRESS 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
1225100000XPhysical Therapist

General Provider Information

NPI Number : 1528513629
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW CHILDRESS DPT
Provider Business Mailing Address
First Line : 6979 TEAYS VALLEY RD
Second Line :
City : SCOTT DEPOT
State : WV
Zip : 25560-7097
Country : US
Telephone Number : 681-235-7156
Fax Number :
Provider Business Practice Location Address
First Line : 6979 TEAYS VALLEY RD
Second Line :
City : SCOTT DEPOT
State : WV
Zip : 25560-7097
Country : US
Telephone Number : 681-235-7156
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2016
Last Update Date : 01/16/2025

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