Provider Demographics
NPI:1720973092
Name:DAMPF, MATTHEW RANDALL (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:RANDALL
Last Name:DAMPF
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 1:4112 GREENBRIER DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-8718
Mailing Address - Country:US
Mailing Address - Phone:573-690-6136
Mailing Address - Fax:
Practice Address - Street 1:2701 W EDGEWOOD DR STE 105
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-5890
Practice Address - Country:US
Practice Address - Phone:573-761-5130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20250208942251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic