MEDICARE: MRS. TONIA MARTA MATWIJCZUK P.T..

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	174400000X	Specialist	PT 7724	TN

General Provider Information

NPI Number	:	1750406419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TONIA MARTA MATWIJCZUK P.T..

Provider Business Mailing Address
First Line	:	104 GLEN OAK BLVD
Second Line	:	SUITE 120
City	:	HENDERSONVILLE
State	:	TN
Zip	:	37075-6423
Country	:	US
Telephone Number	:	615-338-4391
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 GLEN OAK BLVD
Second Line	:	SUITE 120
City	:	HENDERSONVILLE
State	:	TN
Zip	:	37075-6423
Country	:	US
Telephone Number	:	615-338-4391
Fax Number	:

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

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	07/08/2007

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