Active NPI
Matthew Henderson
- Physical Therapist
- Tucker, GA
National Provider Identifier
1427273879
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Practice address
- 4450 Hugh Howell Rd Ste 9
Tucker, GA 30084-4917 - Phone
- (770) 939-0998
- NPI assigned
- Apr 13, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | NU | Primary |
Addresses
Primary practice location
4450 Hugh Howell Rd Ste 9
Tucker, GA 30084-4917
Mailing address
121 Springdale St Apt 17
Decatur, GA 30030-2044
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8771 | Other | GA | LICENSE# |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10009 | CO | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Altitude Physical Therapy & Sports Medicine LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Altitude Physical Therapy - Longmont
- Physical Therapy Clinic/Center
- Longmont, CO
- NPI 1235729567
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176422400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1427273879",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "121 SPRINGDALE ST APT 17",
"city": "DECATUR",
"state": "GA",
"postal_code": "300302044"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4450 HUGH HOWELL RD STE 9",
"city": "TUCKER",
"state": "GA",
"postal_code": "300844917",
"telephone_number": "770-939-0998"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENDERSON",
"first_name": "MATTHEW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE#",
"identifier": "8771",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tucker, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.