Provider Demographics
NPI:1346800414
Name:MURRAY, MATTHEW RYAN (PTA/ATC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:RYAN
Last Name:MURRAY
Suffix:
Gender:M
Credentials:PTA/ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8081 MACON HWY
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-5388
Mailing Address - Country:US
Mailing Address - Phone:706-769-6261
Mailing Address - Fax:
Practice Address - Street 1:8081 MACON HWY
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-5388
Practice Address - Country:US
Practice Address - Phone:706-769-6261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0016082255A2300X
GAPTA001484225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer