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Individual

MATTHEW THOMAS HENRY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MPT

Contact information

Practice address
3051 WATSON BLVD, WARNER ROBINS, GA 31093-8536
(478) 953-4563
(478) 953-4564
Mailing address
113 E. OAK ST., MC RAE, GA 31055-1550
(229) 868-2174
(229) 868-2175

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT008256
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
720012670A
GA
Enumeration date
07/11/2005
Last updated
08/10/2011
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