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General NPI Number Information
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NPI Number | 1518479849
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Entity Type | Individual
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Provider Name | MATTHEW INA PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 10/26/2017
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Last Update Date | 04/19/2024
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Provider Practice Location Address
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Address Line | 3416 S DALE MABRY HWY
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City | TAMPA
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State | FL
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Zip | 33629-8639
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Country | US
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Telephone | 813-215-1357
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Fax |
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Provider Business Mailing Address
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Address Line | 109 W FORTUNE ST APT 3204
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City | TAMPA
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State | FL
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Zip | 33602-3238
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Country | US
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Telephone | 813-215-1357
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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 | 33792
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License Number State | FL
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