Provider Demographics
NPI:1427120617
Name:MATTA, MATTHEW (DPT)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:MATTA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 BROOKS LANE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:JEFFERSON
Mailing Address - State:PA
Mailing Address - Zip Code:15025
Mailing Address - Country:US
Mailing Address - Phone:412-460-8333
Mailing Address - Fax:
Practice Address - Street 1:1200 BROOKS LN
Practice Address - Street 2:SUITE 210
Practice Address - City:CLAIRTON
Practice Address - State:PA
Practice Address - Zip Code:15025-3747
Practice Address - Country:US
Practice Address - Phone:412-460-8333
Practice Address - Fax:412-460-8334
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016509208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA094239MUVMedicare ID - Type Unspecified