Provider Demographics
NPI:1124898176
Name:MATSKO, JOHANNA LU
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:LU
Last Name:MATSKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 RIDGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LEHIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:18235-5344
Mailing Address - Country:US
Mailing Address - Phone:610-714-2492
Mailing Address - Fax:
Practice Address - Street 1:614 INTERCHANGE RD
Practice Address - Street 2:
Practice Address - City:KRESGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:18333-7704
Practice Address - Country:US
Practice Address - Phone:272-639-5350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATPTT023782225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist