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General NPI Number Information
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NPI Number | 1205340064
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Entity Type | Individual
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Provider Name | MATTHEW JOHN HERTZ ATC
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Gender | Male
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Dates
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Enumeration Date | 11/30/2017
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Last Update Date | 11/30/2017
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Provider Practice Location Address
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Address Line | 1100 FOWLER AVE
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City | BERWICK
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State | PA
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Zip | 18603-2300
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Country | US
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Telephone | 570-759-6400
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Fax |
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Provider Business Mailing Address
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Address Line | 115 WOODBINE LN
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City | DANVILLE
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State | PA
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Zip | 17821-9118
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Country | US
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Telephone |
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Fax |
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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 | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | RT006336
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License Number State | PA
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