Individual
ELLIOT RICHARD MATTINGLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
875 PENNSYLVANIA AVE, BARDSTOWN, KY 40004-2529
(502) 349-6961
Mailing address
439 BLOOMFIELD RD, BARDSTOWN, KY 40004-2010
(502) 460-0125
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
005992
KY
Other
Enumeration date
02/27/2012
Last updated
02/27/2012
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