MEDICARE: TINA NICOLE MATTHEWS

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	2314	NC

General Provider Information

NPI Number	:	1871000794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA NICOLE MATTHEWS

Provider Business Mailing Address
First Line	:	18719 CANNON CROSSING WAY
Second Line	:
City	:	DAVIDSON
State	:	NC
Zip	:	28036-8804
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12019 VERHOEFF DR
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-9217
Country	:	US
Telephone Number	:	704-278-0934
Fax Number	:

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

Provider Enumeration Date	:	12/30/2017
Last Update Date	:	12/30/2017

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