Healthcare Provider Details

I. General information

NPI: 1164847703
Provider Name (Legal Business Name): CATHERINE MATTIX L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2014
Last Update Date: 10/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 UNION ST SUITE 6
ERWIN TN
37650-1179
US

IV. Provider business mailing address

4680 CHEROKEE RD
JONESBOROUGH TN
37659-6980
US

V. Phone/Fax

Practice location:
  • Phone: 423-470-4363
  • Fax:
Mailing address:
  • Phone: 423-470-4363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number10473
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: