| Doctor Name: | ELLIOT RICHARD MATTINGLY |
| NPI Number: | 1154695864 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PT, DPT |
| License Number: | 005992 |
| Business Practice Address: | 875 Pennsylvania Ave Bardstown, KY - 400042529 |
| Business Phone Number: | 5023496961 |
| Business Fax Number: | |
| Mailing Address: | 439 Bloomfield Rd, BARDSTOWN |
| State: | KY |
| Postal Code: | 400042010 |
| Phone Number: | 5024600125 |
| Fax Number: | |
| NPI Enumeration Date: | 02/27/2012 |
| NPI Last Update Date: | 02/27/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251X0800X |
| License Number: | 005992 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Orthopedic |
| Taxonomy Definition: | |