Matthew Tyler Douglas, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT010910 Issued in GA

Practice address

97 Gateway Business Park Dr
Ringgold, GA 30736-7395

Phone

(706) 937-5771

Fax

(706) 937-3724

NPI assigned

Jan 8, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• On Deck Physical Therapy and Performance PLLC

  • Physical Therapy Clinic/Center
  • Chattanooga, TN
  • NPI 1649852989
  NPD Authorized official

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

{
    "created_epoch": "1357603200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1393977600000",
    "number": "1245577485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "97 GATEWAY BUSINESS PARK DR",
            "city": "RINGGOLD",
            "state": "GA",
            "postal_code": "307367395",
            "telephone_number": "706-937-5771",
            "fax_number": "706-937-3724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "MATTHEW",
        "middle_name": "TYLER",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-01-08",
        "last_updated": "2014-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TN",
            "license": "9488",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT010910",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Derek Heldzinger Professional, LLC
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• Carissa Dingwall, LPC
• Joe Doss
• John Robert Draper, GCADC-I
• Susan G. Dudley, N.P.
• Baxter Raymond Easler, LPN
• Eddie Test Medical Equipment Inc
• Jennifer Edwards

• Physical Therapist in Ringgold, GA
• Providers in Ringgold, GA by specialty
• Physical Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2014; 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.