Most Relevant Information
Provider Data
| NPI Number: | 1003236506 |
| Provider Name: | AUSTIN MATLOCK ATC |
| Entity Type: | Individual |
| Taxonomy Code: | 2255A2300X |
| Specialty: | Specialist/Technologist |
| License Number: | 2011025934 |
Most Important Dates
| Enumeration Date: | 04/23/2014 |
| Last Updated: | 04/23/2014 |
Provider Practice Location
820 CHESTNUT ST
115 JASON HALL
JEFFERSON CITY
MO
651013537
Practice Location Phone/Fax
| Phone: | 5736815331 |
| Fax: |
Provider Mailing Location
2609A SOUTHRIDGE DR
JEFFERSON CITY
MO
651092069
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |