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NPI Code Detail

MEDICARE: LUIS MATOS

MEDICARE:   LUIS  MATOS
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
1225200000XPhysical Therapy Assistant24297FL

General Provider Information

NPI Number : 1225689854
Entity Type Code : Individual
Provider Name (Legal Business Name) : LUIS MATOS
Provider Business Mailing Address
First Line : 4666 FOUNTAINS DR S
Second Line :
City : LAKE WORTH
State : FL
Zip : 33467-5064
Country : US
Telephone Number : 561-596-8684
Fax Number :
Provider Business Practice Location Address
First Line : 4666 FOUNTAINS DR S
Second Line :
City : LAKE WORTH
State : FL
Zip : 33467-5064
Country : US
Telephone Number : 561-596-8684
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2019
Last Update Date : 09/25/2019

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Directions to “ LUIS MATOS ” Practice Location

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