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General NPI Number Information
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NPI Number | 1356769889
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Entity Type | Individual
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Provider Name | CHRISTINE ASHLEY MATOSIAN DPT
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Gender | Female
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Dates
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Enumeration Date | 04/02/2014
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Last Update Date | 04/02/2014
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Provider Practice Location Address
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Address Line | 350 SEYMOUR AVE
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City | DERBY
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State | CT
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Zip | 06418-1336
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Country | US
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Telephone | 203-732-7445
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Fax |
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Provider Business Mailing Address
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Address Line | 10 HILLCREST AVE
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City | DERBY
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State | CT
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Zip | 06418-2213
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Country | US
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Telephone | 203-231-2274
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 9853
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License Number State | CT
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