Provider Demographics
NPI:1154606796
Name:MATTHEWS, RICHARD ALEXANDER (DPT)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALEXANDER
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 492
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20639-0492
Mailing Address - Country:US
Mailing Address - Phone:410-535-9850
Mailing Address - Fax:
Practice Address - Street 1:110 MAIN STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678
Practice Address - Country:US
Practice Address - Phone:410-535-9850
Practice Address - Fax:410-535-9851
Is Sole Proprietor?:No
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23486225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist