Individual provider Active NPI

Matt Lewis, PHD, LAT, ATC, CSCS

  • Athletic Trainer
  • Harrisburg, PA
National Provider Identifier
1194177485
Registry record updated Jul 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Athletic TrainerTaxonomy code 2255A2300X
License
RT005580 Issued in PA
Practice address
2300 Valley Rd
Harrisburg, PA 17104-1442
Phone
(859) 338-4479
NPI assigned
Jul 11, 2016
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 11, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Athletic Trainer 2255A2300X RT005580 PA Primary

Addresses

Primary practice location

2300 Valley Rd
Harrisburg, PA 17104-1442

Mailing address

2300 Valley Rd
Harrisburg, PA 17104-1442
Phone (859) 338-4479

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
RT005580PAMDAthletic Trainer

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1468195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468195200000",
    "number": "1194177485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 VALLEY RD",
            "city": "HARRISBURG",
            "state": "PA",
            "postal_code": "171041442",
            "telephone_number": "859-338-4479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 VALLEY RD",
            "city": "HARRISBURG",
            "state": "PA",
            "postal_code": "171041442",
            "telephone_number": "859-338-4479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEWIS",
        "first_name": "MATT",
        "name_prefix": "Dr.",
        "credential": "PHD, LAT, ATC, CSCS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-07-11",
        "last_updated": "2016-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "PA",
            "license": "RT005580",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Harrisburg, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.