Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT2194 | AR |
N | 2251S0007X | Physical Therapist - Sports | PT2194 | AR |
N | 2251X0800X | Physical Therapist - Orthopedic | PT2194 | AR |
NPI | 1457316572 |
---|---|
Provider Name | Mr. Matthew Wade Thornton |
First Address | Little Rock, AR 72205 |
Second Address | Little Rock, AR 72205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2006 |
Last Update Date | 20/02/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
152427721 | (05) | AR |