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General NPI Number Information
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NPI Number | 1063828358
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Entity Type | Individual
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Provider Name | TRICIA JENNIFER MATYSAK ATC
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Gender | Female
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Dates
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Enumeration Date | 07/08/2014
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Last Update Date | 07/08/2014
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Provider Practice Location Address
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Address Line | UNIVERSITY OF ARKANSAS 131 BARNHILL ARENA
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City | FAYETTEVILLE
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State | AR
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Zip | 72701-1201
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Country | US
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Telephone | 479-575-4809
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Fax | 479-575-2471
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Provider Business Mailing Address
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Address Line | 4866 W TRAIL DUST ST
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City | FAYETTEVILLE
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State | AR
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Zip | 72704-7671
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Country | US
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Telephone | 479-236-4033
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Fax | 479-575-2471
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT 476
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License Number State | AR
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