Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA18860 | FL |
NPI | 1013994417 |
---|---|
Provider Name | Matthew Corey Matlock |
First Address | Davie, FL 33328-3817 |
Second Address | Davie, FL 33328-3817 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2005 |
Last Update Date | 08/07/2007 |