Healthcare Provider Details

I. General information

NPI: 1962118281
Provider Name (Legal Business Name): MATTHEW HUTTO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2023
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2219 COUNTY ROAD 220 STE 304
MIDDLEBURG FL
32068-7778
US

IV. Provider business mailing address

133 SAN BRISO WAY
ST AUGUSTINE FL
32092-3118
US

V. Phone/Fax

Practice location:
  • Phone: 904-644-7722
  • Fax:
Mailing address:
  • Phone: 386-983-6703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: