MEDICARE: JACQUELINE MICHELE MATAJA PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	23499	FL

General Provider Information

NPI Number	:	1013108034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE MICHELE MATAJA PT

Provider Business Mailing Address
First Line	:	7350 SANDLAKE COMMONS BLVD
Second Line	:	SUITE #3315
City	:	ORLANDO
State	:	FL
Zip	:	32819-8040
Country	:	US
Telephone Number	:	407-345-8500
Fax Number	:	407-345-1146

Provider Business Practice Location Address
First Line	:	7350 SANDLAKE COMMONS BLVD
Second Line	:	SUITE #3315
City	:	ORLANDO
State	:	FL
Zip	:	32819-8040
Country	:	US
Telephone Number	:	407-345-8500
Fax Number	:	407-345-1146

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2007
Last Update Date	:	08/06/2007

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