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NPI Code Detail

MEDICARE: MS. MARY MATTIS P.T.

MEDICARE: MS. MARY MATTIS 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
1225100000XPhysical TherapistPT14465FL
2225100000XPhysical Therapist10091SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1780817148
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARY MATTIS P.T.
Provider Business Mailing Address
First Line : 465 GREENWICH DR
Second Line :
City : AIKEN
State : SC
Zip : 29803-6541
Country : US
Telephone Number : 386-846-7062
Fax Number :
Provider Business Practice Location Address
First Line : 943 PINE LOG RD
Second Line :
City : AIKEN
State : SC
Zip : 29803-7330
Country : US
Telephone Number : 803-649-9797
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/01/2009
Last Update Date : 04/09/2020

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Directions to “ MS. MARY MATTIS P.T.” Practice Location

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