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General NPI Number Information
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NPI Number | 1629215132
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Entity Type | Organization
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Legal Business Name | THOMAS J. MATA SSA, P.T., P.C.
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Dates
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Enumeration Date | 01/21/2009
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Last Update Date | 01/23/2023
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Provider Practice Location Address
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Address Line | 44-27 DOUGLASTON PARKWAY
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City | DOUGLASTON
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State | NY
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Zip | 11363
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Country | US
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Telephone | 718-281-2861
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Fax | 718-281-0173
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Provider Business Mailing Address
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Address Line | 44-27 DOUGLASTON PARKWAY
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City | DOUGLASTON
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State | NY
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Zip | 11363
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Country | US
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Telephone | 718-281-2861
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Fax | 718-281-0173
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. THOMAS JOSEPH MATASSA
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Credential | P.T.
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Telephone | 718-281-2861
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 012203
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License Number State | NY
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