Healthcare Provider Details

I. General information

NPI: 1932656527
Provider Name (Legal Business Name): MATTHEW KATTELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 GLENWOOD RD
BINGHAMTON NY
13905-1603
US

IV. Provider business mailing address

249 GLENWOOD RD
BINGHAMTON NY
13905-1603
US

V. Phone/Fax

Practice location:
  • Phone: 607-240-4828
  • Fax:
Mailing address:
  • Phone: 607-240-4828
  • Fax: 518-583-7606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number040782
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: