MEDICARE: MATTHEW ALLARD

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	225200000X	Physical Therapy Assistant	08593	OH

General Provider Information

NPI Number	:	1790115079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW ALLARD

Provider Business Mailing Address
First Line	:	3957 NATIONAL RD
Second Line	:
City	:	CLAYTON
State	:	OH
Zip	:	45315-8798
Country	:	US
Telephone Number	:	937-974-2216
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 W PETE ROSE WAY
Second Line	:	#225
City	:	CINCINNATI
State	:	OH
Zip	:	45203-1892
Country	:	US
Telephone Number	:	888-752-9640
Fax Number	:

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

Provider Enumeration Date	:	11/22/2013
Last Update Date	:	11/22/2013

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