Provider Demographics
NPI:1306526710
Name:MATTES, VIENNA MARIE (DPT)
Entity type:Individual
Prefix:
First Name:VIENNA
Middle Name:MARIE
Last Name:MATTES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 LYNDON FARM CT STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5005
Mailing Address - Country:US
Mailing Address - Phone:813-560-8157
Mailing Address - Fax:425-452-0704
Practice Address - Street 1:14229 NE WOODINVILLE DUVALL RD STE 25
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-8564
Practice Address - Country:US
Practice Address - Phone:425-658-0110
Practice Address - Fax:425-658-5310
Is Sole Proprietor?:No
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPT61443266OtherWA STATE LICENSE#