Provider Demographics
NPI:1528297041
Name:MOUGHIMAN, MATHEW CLAY (DPT)
Entity type:Individual
Prefix:DR
First Name:MATHEW
Middle Name:CLAY
Last Name:MOUGHIMAN
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 1:1056 EAGLE DR
Mailing Address - Street 2:#809
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-5860
Mailing Address - Country:US
Mailing Address - Phone:330-243-3872
Mailing Address - Fax:
Practice Address - Street 1:55 W WATERLOO RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44319-1116
Practice Address - Country:US
Practice Address - Phone:330-724-7715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT.0124612251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic