Active NPI
Matthew Cook, PTA
- Physical Therapy Assistant
- Russellville, AR
National Provider Identifier
1447657085
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA3821
- Practice address
- 1915 W Main St
Russellville, AR 72801-2725 - Phone
- (479) 968-1198
- Fax
- (479) 967-1178
- NPI assigned
- Nov 25, 2014
- 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 Therapy Assistant | 225200000X | PTA3821 | AR | Primary |
Addresses
Primary practice location
1915 W Main St
Russellville, AR 72801-2725
Mailing address
500 E 3Rd St
Russellville, AR 72801-5204
Phone (479) 968-1198
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTA3821 | AR | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1416873600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1416873600000",
"number": "1447657085",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 E 3RD ST",
"city": "RUSSELLVILLE",
"state": "AR",
"postal_code": "728015204",
"telephone_number": "479-968-1198",
"fax_number": "479-967-1178"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1915 W MAIN ST",
"city": "RUSSELLVILLE",
"state": "AR",
"postal_code": "728012725",
"telephone_number": "479-968-1198",
"fax_number": "479-967-1178"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COOK",
"first_name": "MATTHEW",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-11-25",
"last_updated": "2014-11-25",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "AR",
"license": "PTA3821",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Russellville, AR
- Moriah Conkin, RECOVERY ASSISTANT
- Mary Caitlin Conner, MS, LAC, AADC, LADAC
- Conway County Community Service Inc.
- Conway County Community Service Inc.
- Conway Regional Medical Center, Inc
- Pamela L Cook
- Riley Virginia Cook, PT, DPT
- Melanie Margaret Cooke, LCSW
- Cari D. Cooper, PHARM. D.
- Michael W. Cooper, D.D.S.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 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.