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General NPI Number Information
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NPI Number | 1346976610
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Entity Type | Organization
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Legal Business Name | MATKA PHYSICAL THERAPY PLLC
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Dates
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Enumeration Date | 07/28/2022
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Last Update Date | 07/28/2022
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Provider Practice Location Address
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Address Line | 560 31ST ST
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City | NIAGARA FALLS
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State | NY
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Zip | 14301-2542
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Country | US
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Telephone | 716-425-4025
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Fax |
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Provider Business Mailing Address
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Address Line | 793 CENTER ST # 560
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City | LEWISTON
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State | NY
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Zip | 14092-1705
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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 | OWNER
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Name | KELSEY M WALCK
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Credential | PT, DPT
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Telephone | 716-425-4025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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