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General NPI Number Information
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NPI Number | 1558523399
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Entity Type | Organization
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Legal Business Name | GERALD R. MATTIA D.C., P.A.
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Dates
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Enumeration Date | 07/01/2008
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Last Update Date | 09/24/2008
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Provider Practice Location Address
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Address Line | 8915 CONROY WINDERMERE RD
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City | ORLANDO
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State | FL
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Zip | 32835-3127
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Country | US
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Telephone | 407-909-4788
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Fax | 407-909-1788
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Provider Business Mailing Address
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Address Line | 8915 CONROY WINDERMERE RD
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City | ORLANDO
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State | FL
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Zip | 32835-3127
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Country | US
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Telephone | 407-909-4788
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Fax | 407-909-1788
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GERALD ROBERT MATTIA
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Credential | D.C.
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Telephone | 407-909-4788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH2832
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License Number State | FL
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