Healthcare Provider Details

I. General information

NPI: 1730538166
Provider Name (Legal Business Name): STEVEN MATLAK DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19785 CRYSTAL ROCK DR STE 309
GERMANTOWN MD
20874-4732
US

IV. Provider business mailing address

19785 CRYSTAL ROCK DR STE 309
GERMANTOWN MD
20874-4732
US

V. Phone/Fax

Practice location:
  • Phone: 240-724-6781
  • Fax:
Mailing address:
  • Phone: 240-724-6781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305210240
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number26009
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: