MEDICARE: MATTHEW VASSALOTTI DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist		DE
2	225100000X	Physical Therapist
3	225100000X	Physical Therapist	PT032338	PA

General Provider Information

NPI Number	:	1023670809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW VASSALOTTI DPT

Provider Business Mailing Address
First Line	:	2001 BUTTERFIELD RD STE 1600
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-1211
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4005 LUDLOW ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-5826
Country	:	US
Telephone Number	:	267-529-0050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2019
Last Update Date	:	02/26/2025

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