MEDICARE: DR. MEGAN E MATSEN DPT

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	2251P0200X	Pediatric Physical Therapist	031976	NY

General Provider Information

NPI Number	:	1548570971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MEGAN E MATSEN DPT

Provider Business Mailing Address
First Line	:	3374 FRANKLIN AVE
Second Line	:
City	:	MILLBROOK
State	:	NY
Zip	:	12545-5969
Country	:	US
Telephone Number	:	845-677-6196
Fax Number	:	845-677-0356

Provider Business Practice Location Address
First Line	:	3374 FRANKLIN AVE
Second Line	:
City	:	MILLBROOK
State	:	NY
Zip	:	12545-5969
Country	:	US
Telephone Number	:	845-677-6196
Fax Number	:	845-677-0356

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

Provider Enumeration Date	:	10/19/2010
Last Update Date	:	10/19/2010

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