Provider Demographics
NPI:1427074319
Name:TRNKA, MATTHEW L SR (PT)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:L
Last Name:TRNKA
Suffix:SR
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 1:241 GREAT OAKS TRL
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-9400
Mailing Address - Country:US
Mailing Address - Phone:330-336-8700
Mailing Address - Fax:330-336-8731
Practice Address - Street 1:241 GREAT OAKS TRL
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-9400
Practice Address - Country:US
Practice Address - Phone:330-336-8700
Practice Address - Fax:330-336-8731
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7881225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2537688Medicaid
OH2537688Medicaid