Individual
MATTHEW TYLER DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
97 GATEWAY BUSINESS PARK DR, RINGGOLD, GA 30736-7395
(706) 937-5771
(706) 937-3724
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
9488
TN
225100000X
Physical Therapist
Primary
PT010910
GA
Other
Enumeration date
01/08/2013
Last updated
03/05/2014
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