Provider Demographics
NPI:1174693634
Name:HAYES, MATHEW (PT)
Entity type:Individual
Prefix:MR
First Name:MATHEW
Middle Name:
Last Name:HAYES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:MATT
Other - Middle Name:
Other - Last Name:HAYES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:2001 MALLORY LN
Mailing Address - Street 2:STE 201
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-8233
Mailing Address - Country:US
Mailing Address - Phone:615-373-1350
Mailing Address - Fax:615-221-9054
Practice Address - Street 1:5073 MAIN ST
Practice Address - Street 2:SUITE 120
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-2737
Practice Address - Country:US
Practice Address - Phone:615-302-3564
Practice Address - Fax:302-602-3067
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8032225100000X
TN8823225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO8032OtherLIC NUMBER