Basic Information
| Provider Information | |||||||||
| NPI: | 1053865261 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GALE | ||||||||
| FirstName: | MATTHEW | ||||||||
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| Credential: | PT, DPT, NCS, OCS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2424 DOUBLE CHURCHES RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319092741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7063246112 | ||||||||
| FaxNumber: | 7065968259 | ||||||||
| Practice Location | |||||||||
| Address1: | 2424 DOUBLE CHURCHES RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319092741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7063246112 | ||||||||
| FaxNumber: | 7065968259 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2016 | ||||||||
| LastUpdateDate: | 10/08/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT011937 | GA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.