Healthcare Provider Details

I. General information

NPI: 1720759947
Provider Name (Legal Business Name): MATTERA PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2021
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CEDAR ST
WOBURN MA
01801-7248
US

IV. Provider business mailing address

43 HIGH ST
REVERE MA
02151-2318
US

V. Phone/Fax

Practice location:
  • Phone: 781-521-3336
  • Fax:
Mailing address:
  • Phone: 781-521-3336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. JENNA ANTONETTE MATTERA
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: DPT
Phone: 781-521-3336