Healthcare Provider Details

I. General information

NPI: 1366356446
Provider Name (Legal Business Name): DANIEL MATISOO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

489 WASHINGTON ST STE 200
AUBURN MA
01501-5709
US

IV. Provider business mailing address

489 WASHINGTON ST STE 200
AUBURN MA
01501-5709
US

V. Phone/Fax

Practice location:
  • Phone: 508-721-0000
  • Fax: 508-721-0100
Mailing address:
  • Phone: 508-721-0000
  • Fax: 508-721-0100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number88988
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: