Healthcare Provider Details

I. General information

NPI: 1649866583
Provider Name (Legal Business Name): JESSICA ANN MATIAS PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2020
Last Update Date: 12/15/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6759 SIERRA CT STE A
DUBLIN CA
94568-2657
US

IV. Provider business mailing address

719 JUBILEE LN
SAN LEANDRO CA
94577-1574
US

V. Phone/Fax

Practice location:
  • Phone: 925-803-0530
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number299658
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: