Provider Demographics
NPI:1548364706
Name:MARCHMAN, MATTHEW RAY (PT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:RAY
Last Name:MARCHMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:
Practice Address - Street 1:3425 BUFORD DR
Practice Address - Street 2:STE. 300
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-8785
Practice Address - Country:US
Practice Address - Phone:770-945-1045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT008550225100000X
GA8550171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO807488Medicare PIN