Healthcare Provider Details

I. General information

NPI: 1487790689
Provider Name (Legal Business Name): RAYMOND FRANCIS MATTFELD P.T., A.T.C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 ORINOCO DR
BRIGHTWATERS NY
11718-1307
US

IV. Provider business mailing address

160 ORINOCO DR
BRIGHTWATERS NY
11718-1307
US

V. Phone/Fax

Practice location:
  • Phone: 631-665-9056
  • Fax: 631-665-9058
Mailing address:
  • Phone: 631-665-9056
  • Fax: 631-665-9058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number012480-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number000707-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: