MEDICARE: MR. ALBERT MATIC PT

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	40QA01662300	NJ

General Provider Information

NPI Number	:	1679023055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALBERT MATIC PT

Provider Business Mailing Address
First Line	:	22 WINGED FOOT LN
Second Line	:
City	:	LITTLE EGG HARBOR TWP
State	:	NJ
Zip	:	08087-3004
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	22 WINGED FOOT LN
Second Line	:
City	:	LITTLE EGG HARBOR TWP
State	:	NJ
Zip	:	08087-3004
Country	:	US
Telephone Number	:	954-825-5794
Fax Number	:

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

Provider Enumeration Date	:	10/10/2016
Last Update Date	:	09/13/2024

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