MEDICARE: MATRIX REHABILITATION, INC.

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	261QR0400X	Rehabilitation Clinic/Center		CA

General Provider Information

NPI Number	:	1043254808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATRIX REHABILITATION, INC.

Provider Business Mailing Address
First Line	:	4714 GETTYSBURG RD
Second Line	:
City	:	MECHANICSBURG
State	:	PA
Zip	:	17055-4325
Country	:	US
Telephone Number	:	717-972-1100
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 JOURNEY
Second Line	:	SUITE 101
City	:	ALISO VIEJO
State	:	CA
Zip	:	92656-3372
Country	:	US
Telephone Number	:	949-349-9555
Fax Number	:	949-349-9554

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MICHAEL E. TARVIN
Credential	:
Telephone Number	:	717-972-1100

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	10/26/2018

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