Provider Demographics
NPI:1538398615
Name:CONNELL, MATTHEW CLARK (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:CLARK
Last Name:CONNELL
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5584 AIRLINE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002-9528
Mailing Address - Country:US
Mailing Address - Phone:662-346-6185
Mailing Address - Fax:
Practice Address - Street 1:5584 AIRLINE RD STE 101
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38002-9528
Practice Address - Country:US
Practice Address - Phone:662-346-6185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000007321225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist