Healthcare Provider Details

I. General information

NPI: 1861759664
Provider Name (Legal Business Name): MATTHEW WALTER MATOVU DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2012
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 F ST NW STE 305
WASHINGTON DC
20037-2761
US

IV. Provider business mailing address

2112 F ST NW STE 305
WASHINGTON DC
20037-2761
US

V. Phone/Fax

Practice location:
  • Phone: 202-912-8480
  • Fax: 202-912-8484
Mailing address:
  • Phone: 202-912-8480
  • Fax: 202-912-8484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number24899
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT210002152
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: