Healthcare Provider Details

I. General information

NPI: 1760188569
Provider Name (Legal Business Name): MATTER REHABILITATION PT OT SPEECH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2023
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4307 214TH PL STE 1
BAYSIDE NY
11361-2928
US

IV. Provider business mailing address

8435 PENELOPE AVE
MIDDLE VILLAGE NY
11379-2443
US

V. Phone/Fax

Practice location:
  • Phone: 718-808-9420
  • Fax:
Mailing address:
  • Phone: 347-241-7338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KENNY TA
Title or Position: OWNER
Credential: PT, DPT
Phone: 347-241-7338