Provider Demographics
NPI:1427652973
Name:LE, MATTHEW (AP)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:LE
Suffix:
Gender:M
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5620 E FOWLER AVE STE E
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-2373
Mailing Address - Country:US
Mailing Address - Phone:813-358-7912
Mailing Address - Fax:
Practice Address - Street 1:5620 E FOWLER AVE STE E
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-2373
Practice Address - Country:US
Practice Address - Phone:813-358-7912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP4208171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist