Provider Demographics
NPI:1154357440
Name:MATSAKIS, HEIDI PAULA (ATC)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:PAULA
Last Name:MATSAKIS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:PAULA
Other - Last Name:VON ARX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:2404 STOWE DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-1866
Mailing Address - Country:US
Mailing Address - Phone:951-334-6218
Mailing Address - Fax:
Practice Address - Street 1:2404 STOWE DR
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-1866
Practice Address - Country:US
Practice Address - Phone:951-334-6218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer