Healthcare Provider Details

I. General information

NPI: 1629431325
Provider Name (Legal Business Name): JMATTHEWS PHYSICAL THERAPY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2016
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 W 190TH ST APT 5A
NEW YORK NY
10040-3939
US

IV. Provider business mailing address

802 W 190TH ST APT 5A
NEW YORK NY
10040-3939
US

V. Phone/Fax

Practice location:
  • Phone: 646-704-4560
  • Fax:
Mailing address:
  • Phone: 646-704-4560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number22249
License Number StateNY

VIII. Authorized Official

Name: JASON W MATTHEWS
Title or Position: PHYSICAL THERAPIST
Credential: P.T.
Phone: 646-704-4560