Individual
MATT C PAUL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
12722 TONKEL RD STE 102, FORT WAYNE, IN 46845-8201
(260) 739-0300
Mailing address
12722 TONKEL RD STE 102, FORT WAYNE, IN 46845-8201
(260) 905-2129
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05013789A
LICENSE
IN
05
—
300041301
—
IN
Enumeration date
08/04/2020
Last updated
05/05/2026
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