Healthcare Provider Details

I. General information

NPI: 1083402630
Provider Name (Legal Business Name): MATSAN THERAPY & REHAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2025
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 DUPONT CIR STE 569
LOUISVILLE KY
40207-4888
US

IV. Provider business mailing address

4010 DUPONT CIR STE 569
LOUISVILLE KY
40207-4888
US

V. Phone/Fax

Practice location:
  • Phone: 502-276-1959
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: GIANNYS MATO
Title or Position: PRESIDENT
Credential:
Phone: 502-276-1959