MEDICARE: DAWN M MATTLE 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	012242	NY

General Provider Information

NPI Number	:	1740256627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWN M MATTLE PT

Provider Business Mailing Address
First Line	:	3506 THOMAS DRIVE
Second Line	:
City	:	LAKEVILLE
State	:	NY
Zip	:	14480
Country	:	US
Telephone Number	:	585-346-0060
Fax Number	:	585-346-0108

Provider Business Practice Location Address
First Line	:	3506 THOMAS DRIVE
Second Line	:
City	:	LAKEVILLE
State	:	NY
Zip	:	14480
Country	:	US
Telephone Number	:	585-346-0060
Fax Number	:	585-346-0108

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

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	06/19/2009

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