Provider Demographics
NPI:1124084421
Name:KICKLIGHTER, MATTHEW (ATC/L)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:KICKLIGHTER
Suffix:
Gender:M
Credentials:ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8328 TRADING POST CT
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-6520
Mailing Address - Country:US
Mailing Address - Phone:615-418-1033
Mailing Address - Fax:
Practice Address - Street 1:3200 MEDICAL CENTER
Practice Address - Street 2:VANDERBILT UNIVERSITY MED, SOUTH TOWER SUITE 3200
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212
Practice Address - Country:US
Practice Address - Phone:615-322-7878
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9542255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer