Provider Demographics
NPI:1184291858
Name:CARMICHAEL, MATTHEW PAUL (BS, ATC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:PAUL
Last Name:CARMICHAEL
Suffix:
Gender:M
Credentials:BS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 SOMERSET PL
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-3424
Mailing Address - Country:US
Mailing Address - Phone:732-882-6295
Mailing Address - Fax:
Practice Address - Street 1:12 SOMERSET PL
Practice Address - Street 2:
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-3424
Practice Address - Country:US
Practice Address - Phone:732-882-6295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer