MEDICARE: MR. JOEL R MATUSKEY 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	2251X0800X	Orthopedic Physical Therapist	14312	MD

General Provider Information

NPI Number	:	1619961992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOEL R MATUSKEY PT

Provider Business Mailing Address
First Line	:	1112 N ROLLING RD
Second Line	:
City	:	CATONSVILLE
State	:	MD
Zip	:	21228-3826
Country	:	US
Telephone Number	:	410-869-3112
Fax Number	:	410-869-3115

Provider Business Practice Location Address
First Line	:	1112 N ROLLING RD
Second Line	:
City	:	CATONSVILLE
State	:	MD
Zip	:	21228-3826
Country	:	US
Telephone Number	:	410-869-3112
Fax Number	:	410-869-3115

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

Provider Enumeration Date	:	09/01/2005
Last Update Date	:	11/15/2007

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