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NPI Code Detail

MEDICARE: CHRISTOPHER PEREZ MATTESON P.T

MEDICARE:   CHRISTOPHER PEREZ MATTESON  P.T
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
1225100000XPhysical TherapistPT25346CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10PT253460OTHERCAPPIN

General Provider Information

NPI Number : 1962583377
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTOPHER PEREZ MATTESON P.T
Provider Business Mailing Address
First Line : 85 SIERRA PARK RD
Second Line :
City : MAMMOTH LAKES
State : CA
Zip : 93546-2073
Country : US
Telephone Number : 760-934-3311
Fax Number :
Provider Business Practice Location Address
First Line : 85 SIERRA PARK RD
Second Line :
City : MAMMOTH LAKES
State : CA
Zip : 93546-2073
Country : US
Telephone Number : 760-934-3311
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2006
Last Update Date : 02/11/2021

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