Provider Demographics
NPI:1528786084
Name:HARRIS, MATTHEW JUSTIN (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JUSTIN
Last Name:HARRIS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 CABOT DR APT 913
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-4389
Mailing Address - Country:US
Mailing Address - Phone:248-820-9187
Mailing Address - Fax:
Practice Address - Street 1:198 HILLVIEW ST
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-1285
Practice Address - Country:US
Practice Address - Phone:615-446-8159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14410225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist